Psychiatric comorbidity in parents with alcohol disorders and out-of-home care placements in Sweden

Parental alcohol use disorder (AUD) is a major driver of child welfare involvement, yet AUD rarely occurs in isolation. Psychiatric comorbidities may influence caregiving capacity and decisions about out‑of‑home care (OHC). Little is known about gender‑specific comorbidity profiles among parents with AUD and their association with children’s OHC risk. Using the Swedish families born in the 1990’s, a population-based register cohort (435,835 parents), we identified all parents with AUD and reviewed psychiatric diagnoses (ICD 9 and 10) recorded in inpatient care over two years before the child’s first placement (or matched year for non‑placed children). Latent class analysis was done separately for mothers and fathers to find comorbidity clusters. Logistic regression estimated odds ratios (ORs) for OHC by parental AUD and cluster, adjusting for education, income, number of children, and country of birth. Parents with AUD (3,061 0.7% mothers; 7,466 1.7% fathers) were more socioeconomically disadvantaged than those without AUD; 3.3% of children were placed in OCH. Four heterogeneous gender-specific comorbidity profiles emerged. Cluster 1 is a low‑comorbidity AUD group. Cluster 2 shows elevated substance use and personality/psychopathology. Cluster 3 reflects mood/neurotic disorders. Cluster 4 is the most severe, with high prevalence across substance, mood, personality, and other diagnoses. Children of parents with AUD had much higher odds of OHC (adjusted OR = 8.88 mothers; 5.95 fathers), with elevated odds across clusters, especially for mothers in cluster 4 (OR = 10.72) and fathers in cluster 2 (OR = 9.32). AUD psychiatric comorbidity clusters are broadly similar across genders, with differences in specific diagnoses; these profiles are strongly associated with children’s risk of OHC placement even after accounting for socioeconomic disadvantage. Identifying comorbidity patterns may support earlier, more tailored interventions for families affected by AUD.

Key messages

• Parental alcohol disorders are associated with distinct, gender-specific psychiatric comorbidity profiles that substantially increase children’s odds of out-of-home care placement.

• Identifying comorbidity patterns among parents with AUD can support earlier, more targeted interventions to reduce children’s elevated chances of removal.