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      Adolescent conduct problems and premature mortality: follow-up to age 65 years in a national birth cohort

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          Abstract

          Background

          Severe youth antisocial behaviour has been associated with increased risk of premature mortality in high-risk samples for many years, and some evidence now points to similar effects in representative samples. We set out to assess the prospective association between adolescent conduct problems and premature mortality in a population-based sample of men and women followed to the age of 65 years.

          Method

          A total of 4158 members of the Medical Research Council National Survey of Health and Development (the British 1946 birth cohort) were assessed for conduct problems at the ages of 13 and 15 years. Follow-up to the age of 65 years via the UK National Health Service Central Register provided data on date and cause of death.

          Results

          Dimensional measures of teacher-rated adolescent conduct problems were associated with increased hazards of death from cardiovascular disease by the age of 65 years in men [hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.04–1.32], and of all-cause and cancer mortality by the age of 65 years in women (all-cause HR 1.16, 95% CI 1.07–1.25). Adjustment for childhood cognition and family social class did little to attenuate these risks. Adolescent conduct problems were not associated with increased risks of unnatural/substance-related deaths in men or women in this representative sample.

          Conclusions

          Whereas previous studies of high-risk delinquent or offender samples have highlighted increased risks of unnatural and alcohol- or substance abuse-related deaths in early adulthood, we found marked differences in mortality risk from other causes emerging later in the life course among women as well as men.

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          Most cited references12

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          The life course prospective design: an example of benefits and problems associated with study longevity.

          W S Hilder, D Kuh, Michael E J Wadsworth … (2003)
          Although the life course prospective study design has many benefits, and information from such studies is in increasing demand for scientific and policy purposes, it has potential inherent design problems associated with its longevity. These are in particular the fixed sample structure and the data collected in early life, which are each determined by the scientific principles of another time and the risk over time of increased sample loss and distortion through loss. The example of a national birth cohort in Britain, studied from birth so far to age 53 years is used to address these questions. Although the response rate is high, avoidable loss, which was low in childhood, increased in adulthood, and was highest in those in adverse socio-economic circumstances and those with low scores on childhood cognitive measures. Recent permanent refusal rate rises may be the result of better tracing and/or a response to increased requests for biological measurement. Nevertheless, the responding sample continues in most respects to be representative of the national population of a similar age. Consistency of response over the study's 20 data collections has been high. The size of the sample responding in adulthood is adequate for the study of the major costly diseases, and for the study of functional ageing and its precursors. This study's continuation has depended not only on scientific value but also policy relevance. Although the problems inherent in the prospective design are unavoidable they are not, in the study described, a barrier to scientific and policy value. That seems also likely in Britain's two later born national birth cohort studies that have continued into adulthood.
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            Adult physical health outcomes of adolescent girls with conduct disorder, depression, and anxiety.

            Sarah Moffitt, Duílio M. Z. de A. Silva, N Dickson … (1998)
            To examine the young adult physical health outcomes of adolescent girls with behavior problems. Girls with conduct disorder, girls with depression, girls with anxiety, and healthy girls (N = 459) who had been evaluated at age 15 years were followed up at age 21, when general physical health, substance dependence, and reproductive health were assessed. After control for potentially confounding variables including prior health, adolescent conduct disorder predicted more medical problems, poorer self-reported overall health, lower body mass index, alcohol and/or marijuana dependence, tobacco dependence, daily smoking, more lifetime sexual partners, sexually transmitted disease, and early pregnancy. Adolescent depression predicted only adult tobacco dependence and more medical problems; adolescent anxiety predicted more medical problems. The robust link between female adolescent conduct disorder and poor physical health in adulthood suggests that intervention with girls who have conduct disorder may be a strategy for preventing subsequent health problems.
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              Childhood problem behaviors and death by midlife: the British National Child Development Study.

              Markus Jokela, Jane Ferrie, Mika Kivimäki (2009)
              To examine childhood problem behaviors manifested as externalizing behaviors (e.g., aggression, impulsivity) and internalizing behaviors (e.g., anxiousness, avoidant behavior) as predictors of mortality by the age of 46 years and to assess whether these associations are dependent on childhood family background. The participants were 5,426 girls and 5,716 boys born in 1958 and participants in the British National Child Development Study (total N = 11,142). Childhood problem behaviors were assessed by teachers at ages 7 and 11 years, and the participants were followed for mortality to the age of 46 years. Both externalizing and internalizing behaviors were associated with mortality in adulthood. By the age of 46 years, the cumulative probabilities of death by increasing externalizing score quartiles were 1.4%, 2.2%, 2.3%, and 3.2%, respectively (odds ratio [OR] for mortality per 1 SD increase in standardized externalizing score 1.27; 95% confidence interval [CI] 1.13-1.44). The corresponding percentages for internalizing score quartiles were 1.8%, 1.9%, 2.3%, and 3.0% (OR 1.20; 95% CI 1.06-1.35). Adjusting for father's social class, family difficulties, family size, and cognitive ability attenuated these associations for externalizing behaviors (OR 1.21; 95% CI 1.06-1.37) and for internalizing behaviors (OR 1.11; 95% CI 0.98-1.26). Childhood environment did not modify the association between problem behaviors and mortality. Childhood problem behaviors are associated with increased long-term mortality risk beyond childhood and adolescence.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Psychol Med
                Journal ID (iso-abbrev): Psychol Med
                Journal ID (publisher-id): PSM
                Title: Psychological Medicine
                Publisher: Cambridge University Press (Cambridge, UK )
                ISSN (Print): 0033-2917
                ISSN (Electronic): 1469-8978
                Publication date (Print): April 2014
                Publication date (Electronic): 21 August 2013
                Volume: 44
                Issue: 5
                Pages: 1077-1086
                Affiliations
                [1 ]MRC Social, Genetic and Developmental Psychiatry Centre at King's College London Institute of Psychiatry , London, UK
                [2 ]MRC Unit for Lifelong Health and Ageing , London, UK
                Author notes
                [* ]Address for correspondence: M. Stafford, MRC Unit for Lifelong Health and Ageing , 33 Bedford Place, London WC1B 5JU, UK. (Email: m.stafford@ 123456nshd.mrc.ac.uk )
                Article
                Publisher Item ID: S0033291713001402 Publisher ID: 00140
                DOI: 10.1017/S0033291713001402
                PMC ID: 3948505
                PubMed ID: 23962416
                SO-VID: 6d6ddf28-0258-4699-8825-0fc1bc81ac7a
                Copyright © © Cambridge University Press 2013
                License:

                The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution licence < http://creativecommons.org/licenses/by/3.0/.

                History
                Date received : 16 November 2012
                Date revision received : 10 May 2013
                Date accepted : 20 May 2013
                Page count
                Figures: 2, Tables: 2, References: 29, Pages: 10
                Categories
                Subject: Original Articles

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: conduct problems,life course,mortality,national survey of health and development
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: conduct problems, life course, mortality, national survey of health and development

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