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Millions of people in the United States have a personal connection to adoption—people who relinquished children to adoption, who chose to adopt, or who are themselves adopted.
For many adopted individuals, adoption is not a one-time event in childhood but an ongoing process that continues to shape their lives. For many adopted people, being adopted is an important part of a multi-faceted identity with implications across the lifespan. For decades, adult adoptees have described how being adopted and having limited family medical history affects both their wellness and healthcare experiences.
Regardless of whether you are adopted, care for an adopted person, or are a clinician hoping to understand your patients better, we invite you to explore the information and resources around healthcare for adoptees. While far from comprehensive, we highlight several key health issues including adoption, limited family medical history, mental health, and genetic testing.
Introduction
In the United States, it is estimated that over 7.8 million people are adopted. The Evan B. Donaldson Adoption Institute found that in 2002, 64% of Americans reported a personal connection to an adopted person. Among adoptees, a significant portion do not have access to their family medical history. While a patient may have limited family medical history (LFMH) for many reasons, including limited access to healthcare, limited health literacy, separation and estrangement, adoptees face significant legal, financial, and linguistic barriers preventing access to their family medical history.
Adult adoptees’ LFMH and increased likelihood of adverse childhood experiences (ACEs) may challenge PCPs’ ability to provide quality health care. A 2013 study published in Pediatrics observed that adoptees are 3.7 times more likely to report attempted suicide than their non-adopted siblings. While research and clinical resources exist for pediatricians caring for adopted children with LFMH, this has not extended to adopted adult patients with LFMH. Although adoption bears lifelong implications for mental health, medical management, and reproductive decision-making, medical literature on caring for adult adopted patients with LFMH is sparse.
The growing affordability and popularity of genetic testing, especially recreational direct-to-consumer genetic testing kits in recent years has only amplified the need for the medical community to address questions regarding genetic testing in the context of patients with LFMH. Adopted patients increasingly wish to discuss genetic testing and LFMH with their PCPs.
Lastly, numerous patient narratives have illustrated that clinical encounters may trigger medical anxiety, shame, guilt, and distrust among adult adoptees with LFMH. Patients report experiencing microaggressions around adoption, multiracial family, and ethnic or racial identity.