This article is more than 5 years old. Information may no longer be current.

Youth with conduct disorders at higher risk for premature death

Teenagers and young adults with conduct and substance use disorders and their siblings were at almost five times higher risk for premature death than community controls, according to study findings published in Addiction.

“American youth who engage in risk behaviors, such as substance abuse and criminal activities, are two to nine times more likely to die prematurely than their general population counterparts,” Richard Border, PhD candidate from the University of Colorado Boulder, and colleagues wrote. “No prior study has analyzed the independent contributions of conduct disorder and substance use disorders among legally ascertained youth to determine hazard of premature death despite evidence of substantial psychiatric morbidity in delinquent youth populations and elevated mortality risk in clinically ascertained youth.”

The investigators examined common and independent factors that contribute to mortality risk in teens ascertained for conduct disorder and substance use disorder, their siblings and community controls to determine whether individual differences in disorder severity would explain unique differences in mortality risk beyond risk related to clinical/control status and demographics.

In this prospective study, researchers recruited 1,463 youth with conduct disorder and substance use disorder — via the juvenile correctional system, court-mandated substance abuse treatment programs and correctional schools — 1,399 of their siblings and 904 controls. They assessed cause-of-death using National Death Index search.

In total, 104 deaths occurred among 3,766 teenagers and young adults. Youth with conduct and substance use disorders had 1.95 times the expected hazard as their siblings (P = .002) who, in turn, had 3.58 times the expected hazard, as did controls (P = .001), according to the results. Together, clinical probands and their siblings were at 4.99 times greater risk for death than controls (95% CI, 2.4-10.4). Most deaths among clinical participants and their siblings were attributable to substance-related and violent causes, and the substance use-related causes accounted for 32% of deaths among clinical probands.

Conduct disorder independently predicted mortality risk, but substance use disorder severity did not, after accounting for potential confounders. According to univariate model analysis, male sex, conduct problems and substance abuse/dependence were each linked to increased mortality risk. The results also showed that males were at 2.81 times higher risk for premature death than females (P < .001).

“The degree to which forensic artifacts surrounding cause-of-death classification account for the incidence of substance-related deaths among clinically and legally ascertained youth comprises a prime target for future research efforts,” Border and colleagues wrote. “We wish to caution that although it remains unclear which domains comprise the most pressing target for intervention and prevention efforts ... it is clear that youth identified with conduct problems are at extreme risk for premature mortality and in critical need of greater resources.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.