Criminal behavior in alcohol-related dementia and Wernicke-Korsakoff syndrome: a Nationwide Register Study.

BACKGROUND: Chronic heavy alcohol use may lead to permanent brain damage, cognitive impairment, and dementia. While the link between alcohol use and crime is strong, virtually no research exists on the criminal behavior of patients with the alcohol-related neurocognitive disorders of Wernicke-Korsakoff syndrome (WKS) and alcohol-related dementia (ARD). METHODS: The study population included all persons diagnosed with WKS (n = 1149) or ARD (n = 2432) in Finland in 1998-2015. Data on diagnoses, mortality, and crime were obtained from Finnish nationwide registers. Crime incidences were calculated 4 years before and after diagnosis. Crime types, incidences, and mortality were compared between disorders and with the general population. RESULTS: Altogether 35.6% of WKS patients and 23.6% of ARD patients had committed crimes in the 4 years preceding diagnosis, most commonly property and traffic crimes, followed by violent crimes. The incidence of criminal behavior decreased significantly after diagnosis; in WKS patients, the standardized criminality ratio (SCR), the ratio of observed to expected number of crimes (95% CI), was 3.91 (3.72-4.10) in 4 years before and 2.80 (2.61-3.00) in 4 years after diagnosis. Likewise, in ARD patients, the SCRs were 2.63 (2.51-2.75) before and 0.84 (0.75-0.92) after diagnosis. No significant difference emerged in mortality between persons with and without a criminal history. CONCLUSIONS: Persons with alcohol-related neurocognitive disorders frequently engage in criminal behavior prior to diagnosis, especially multiple offending. In the 4 years before and after diagnosis, crime rates declined in a linear fashion, with a marked reduction after diagnosis.

Suicides in degenerative neurocognitive disorders and traumatic brain injuries.

BACKGROUND: Neuropsychiatric symptoms in major neurocognitive disorders have been strongly associated with suicidality. METHODS: The objectives were to explore suicide rates in degenerative neurocognitive disorders (DNDs), alcohol-related neurocognitive disorders (ARNDs), and traumatic brain injuries (TBIs). Patients who received these diagnoses between 1998 and 2015 (N = 231,817) were identified from nationwide registers, and their mortality was followed up until December 31, 2018. We calculated incidences of suicides per 100,000 person-years, types of suicides, and suicide rates compared with the general population (standardized mortality ratio [SMR]). RESULTS: During the follow-up, 0.3% (95% confidence interval [95% CI]: 0.2-0.5) of patients with DNDs, 1.1% (0.7-1.8) with ARNDs, and 1.0% (0.7-1.3) with TBIs committed suicide. Suicide mortality rate was higher in men (58.9, 51.3, to 67.4 per 100,000) than in women (9.8, 7.5, to 12.5 per 100,000). The highest suicide rate was in ARNDs (98.8, 65.1, to 143.8 per 100,000), followed by TBIs (82.0, 62.4, to 105.8 per 100,000), and DNDs (21.2, 18.3, to 24.5 per 100,000). The SMRs (95% CI) were 3.69 (2.53-5.38), 2.99 (2.31-3.86), and 1.31 (1.13-1.51), respectively, and no sex difference emerged. The most common cause of death was self-inflicted injury by hanging or drowning (12.4, 10.3, to 14.8 per 100,000). CONCLUSIONS: Suicide rates were higher in all three patient groups than the general population. Suicide risk remained elevated for more than 10 years after diagnosis. The suicide methods were mostly violent.

Antipsychotic Use and Mortality in Persons with Alcohol-Related Dementia or Wernicke-Korsakoff Syndrome: A Nationwide Register Study in Finland.

BACKGROUND: Research on the use of psychotropic drugs in people with alcohol-related neurocognitive disorders is virtually nonexistent. We examined the prevalence of antipsychotic drug use and its effect on mortality among patients with Wernicke-Korsakoff syndrome (WKS) or alcohol-related dementia (ARD). METHODS: In this nationwide register study, we collected data on the medication use and mortality of all persons aged ≥40 diagnosed with WKS (n = 1149) or ARD (n = 2432) between 1998 and 2015 in Finland. We calculated the prevalence of antipsychotic use within one year of diagnosis and the adjusted cumulative mortality of antipsychotic users versus non-users in relation to the age-, sex-, and calendar year-matched general population. RESULTS: Of the WKS and ARD patients, 35.9% and 38.5%, respectively, purchased one or more antipsychotic drugs in the year following diagnosis. The adjusted cumulative mortality of the antipsychotic users was significantly lower than that of non-users in both the WKS and ARD groups, where the adjusted hazard ratios (95% CI) were 0.85 (0.72-0.99) and 0.73 (0.65-0.81), respectively. WKS and ARD patients using antipsychotics were less likely to die of alcohol-related causes than antipsychotic non-users, but the difference was significant only in the ARD group. CONCLUSIONS: This population-based study shows that antipsychotic use is common in patients with WKS or ARD. In contrast to other dementia studies, our results indicate that the mortality of antipsychotic users is significantly lower than that of non-users. The lower mortality could be explained by decreased alcohol use and better healthcare coverage in antipsychotic users.

Criminal Behaviour After Diagnosis of a Neurocognitive Disorder: A Nationwide Finnish Register Study.

OBJECTIVE: To explore criminal behavior of individuals with Alzheimer's disease (AD), frontotemporal dementia (FTD), or Lewy body dementias (LBD) after the diagnosis. DESIGN: Nationwide register study. SETTING: Information on diagnoses and criminality was received from Finnish registers. Crime types and incidences were compared between disorders and the general population. PARTICIPANTS: All Finnish individuals diagnosed with AD, LBD, or FTD (n = 92 189) during 1998-2015. MEASUREMENTS: Types of crimes and incidences, the standardized criminality ratio (SCR, number of actual crimes per number of expected crimes), numbers of observed cases, and person-years at risk counted in 5-year age groups and for both sexes and yearly. RESULTS: Among men, at least one crime was committed by 2.8% of AD, 7.2% of FTD, and 4.8% of LBD patients. Among women, the corresponding figures were 0.4%, 2.0%, and 2.1%. The most frequent type of crime was traffic offence, followed by property crime. After age adjustment, the relative number of crimes between groups did not differ, except that men with FTD and LBD committed more crimes than those with AD. The SCR (95% CI) among men were 0.40 (0.38-0.42) in AD, 0.45 (0.33-0.60) in FTD, and 0.52 (0.48-0.56) in LBD. Among women, these were 0.34 (0.30-0.38), 0.68 (0.39-1.09), and 0.59 (0.51-0.68). CONCLUSIONS: The diagnosis of a neurocognitive disorder does not increase criminal behavior, but rather reduces it by up to 50%. Differences in crime activity are present between different neurocognitive disorders and between the sexes.

Bullying at 8 years and violent offenses by 31 years: the Finnish nationwide 1981 birth cohort study.

This study explored the associations between bullying perpetration and victimization at 8 years of age and violent offenses by the age of 31. Data were obtained for subjects enrolled in a population-based longitudinal birth cohort study. In 1989, 5813 8-year-old children (attrition 3.4%), and their parents and teachers, were surveyed about bullying. When 5405 subjects (attrition 10.2%) were 15-31 years of age, violent offenses were extracted from the Finnish National Police Register. We analyzed the data by sex and categorized bullying perpetration and victimization by frequency. Violent offenses were categorized by severity. Cox regression analyses estimated the hazard ratios (HRs) and 95% confidence intervals (95% CIs). When they were compared to males who had not been bullies at 8 years of age, frequent male bullies had an increased hazard for violent offenses (adjusted HR 3.01, 95% CI 2.11-4.33) and severe violent offenses (adjusted HR 2.86, 95% CI 1.07-7.59) as adults, even when the data were controlled for them being victims, parental education level, family structure and child psychopathology. Frequent female bullies also had an increased hazard for violent offenses, compared to those who had not bullied others (adjusted HR 5.27, 95% CI 1.51-18.40). Frequent male bullying was associated with higher odds for violent offenses compared to only bullying sometimes. Being a victim was not associated with violent offenses. Preventing childhood bullying could reduce violent offenses by both sexes.

Crime, mortality and neurocognitive disorders: A nationwide register study in Finland.

OBJECTIVES: To explore mortality of patients with Alzheimer's disease (AD), frontotemporal dementia (FTD), or Lewy body dementias (LBD) who had criminal behavior in the year preceding diagnosis. METHODS: Data were obtained from the nationwide registers. Mortality was compared between disorder groups with and without criminal acts and with the general population. The cohort included patients who had received a discharge register diagnosis of AD (N = 80,540), FTD (N = 1060), or LBD (N = 10,591) between 1998 and 2015. The incidences of crimes were calculated in the year preceding diagnosis. We further calculated age- and sex-adjusted survivals of different dementia groups with and without criminal acts, and in relation to the general population (SMR, Standardized Mortality Ratio). RESULTS: Criminal behavior was more common in men than in women. It was associated with decreased mortality in the AD group. SMRs due to unnatural causes, and in the LBD and FTD female groups, were higher in patients with criminal behavior than in those without. CONCLUSION: LBD and female FTD patients, who had criminal behavior before diagnosis, were at higher risk of death than patients without such behavior. Novel criminality in older adults may be associated with neurocognitive disorder, in which case medical attention is justified.

Incidence and mortality of alcohol-related dementia and Wernicke-Korsakoff syndrome: A nationwide register study.

BACKGROUND: Epidemiological data on alcohol-related cognitive disorders are scarce. Up-to-date population-based incidence and mortality rates for Wernicke-Korsakoff syndrome (WKS) and alcohol-related dementia (ARD) are necessary to understand the burden of these diseases. METHODS: We collected diagnostic data from the Finnish Hospital Discharge Register and mortality data from Statistics Finland for all persons aged ≥40 years who had received a diagnosis of WKS (n = 1149) or ARD (n = 2432) between 1998 and 2015 in Finland. We calculated the incidences and mortality in relation to the age-, sex- and calendar year-matched general population. Causes of death were ascertained from death certificates. RESULTS: For WKS, the incidence per 100,000 person-years (95% confidence interval (CI)) was 3.7 (3.4-3.9) in men and 1.2 (1.1-1.3) in women. For ARD, the incidence was 8.2 (7.9-8.6) in men and 2.1 (1.9-2.3) in women. The incidence of WKS peaked in people aged 50-59 years and the incidence of ARD in people aged 70-79 years. The standardized mortality ratio (95% CI) was 5.67 (5.25-6.13) in WKS patients and 5.41 (5.14-5.70) in ARD patients. Most of the excess mortality resulted from alcohol-related causes. CONCLUSIONS: To our knowledge, this is the first study describing population-based incidence and mortality rates, sex-segregated data and causes of death in patients with WKS or ARD. Our results establish a point of reference for the incidence of WKS and ARD and show the high mortality and poor prognosis of these disorders.

The long-term cost of childhood conduct problems: Finnish Nationwide 1981 Birth Cohort Study.

BACKGROUND: Commonly recognized childhood conduct problems often lead to costly problems in adulthood. This study aimed to evaluate the long-term cumulative cost of childhood conduct problems until the age of 30. The costs included inpatient care, nervous system medicine purchases, and criminal offences. METHODS: The study used population-based nationwide 1981 birth cohort data. Families and teachers assessed the conduct problems of the eight-year-olds based on Rutter questionnaires. We grouped 5,011 children into low-level of conduct problems (52%), intermediate-level of conduct problems (37%), and high-level of conduct problems (11%) groups, based on combined conduct symptoms scores. The analysis included the cohort data with the Care Register for Health Care, the Drug Prescription Register, and the Finnish Police Register. The cost valuation of service use applied national unit costs in 2016 prices. We used Wilcoxon rank-sum test to test the differences between groups and gender. RESULTS: During 1989-2011, average cumulative costs of the high-level (€44,348, p < .001) and the intermediate-level (€19,405, p < .001) of conduct problems groups were higher than the low-level of conduct problems group's (€10,547) costs. In all three groups, the boys' costs were higher than girls' costs. CONCLUSIONS: The costs associated with conduct problems in childhood are substantial, showing a clear need for cost-effective interventions. Implementation decisions of interventions benefit from long-term cost-effectiveness modelling studies. Costing studies, like this, provide cost and cost offset information for modelling studies.

Criminal Behavior in the Four Years Preceding Diagnosis of Neurocognitive Disorder: A Nationwide Register Study in Finland.

OBJECTIVE: To explore the criminality of patients with subsequent diagnosis of Alzheimer's disease (AD), frontotemporal dementia (FTD), or Lewy body dementias (LBD) in the four years preceding diagnosis. DESIGN: Nationwide register study. SETTING: Data on Finnish patients were collected from the discharge register and data on criminal offending from the police register. Research findings were compared with the same-aged general population. PARTICIPANTS: A total of 92,191 patients who had received a diagnosis of AD (N = 80,540), FTD (N = 1,060), and LBD (N = 10,591) between 1998 and 2015. MEASUREMENTS: Incidences and types of crimes, the standardized criminality ratio (number of actual crimes per number of expected crimes), and the numbers of observed cases and person-years at risk counted in five-year age groups and separately for both genders and yearly. RESULTS: At least one crime was committed by 1.6% of AD women and 12.8% of AD men, with corresponding figures of 5.3% and 23.5% in FTD, and 3.0% and 11.8% in LBD. The first crime was committed on average 2.7 (standard deviation 1.1) years before the diagnosis. The standardized criminality ratio was 1.85 (95% confidence interval [CI] 1.43-2.37) in FTD women and 1.75 (95% CI 1.54-1.98) in FTD men, and in AD 1.11 (95% CI 1.04-1.17) and 1.23 (95% CI 1.20-1.27), respectively. Traffic offences and crimes against property constituted 94% of all offences. CONCLUSION: Criminal acts may occur several years prior to the diagnosis of dementia. If novel criminality occurs later in life, it may be associated with neurocognitive disorder.

Crime and mortality in a population-based nationwide 1981 birth cohort: Results from the FinnCrime study.

BACKGROUND: Offending is known to be associated with various health problems and premature death, but previous studies on associations between offending and mortality have often been only with men, convicted offenders or highly selected samples. A more sensitive measure of offending may be preferable when trying to understand the extent of health disadvantages among people who offend. AIMS: The aim of this paper was to study the associations between investigated offending, death and causes of death in a nationally representative birth cohort. METHODS: A broad concept of offending was used such that people who had had any contact with the police because they had been suspected of crime were included. Offending data were obtained from the National Police Register for 5405 men and women born in Finland in 1981, spanning their ages 15-30 years; mortality data were received from Statistics Finland. Offending was classified into four categories by frequency: none, 1-4 different offence contacts, 5-27 and 28 or more. Causes of death were categorised into natural, accidents, suicide or homicide. Of the cohort, 2304 (43%) had offended and 57 (1.1%) had died. Associations between offending, mortality and causes of death were analysed, controlling for parental education level and family structure in childhood. RESULTS: The mortality rate was higher among offenders than non-offenders, increasing with rising frequency of offending. The most frequent offenders were nearly 30 times more likely to have died by age 30 than non-offenders (odds ratio 28.6, confidence interval 12.1-67.5); risk was higher for female than male offenders. Death among offenders was less likely to be from natural causes. IMPLICATIONS: A heightened risk of premature death is the ultimate form of adverse outcome for offenders. Offenders' health is likely to need more attention as part of their overall management, for recidivists in particular. In our study, offenders' only certain criminal justice contact was with the police, so it may be that the police should take a greater role in signposting them towards health services. Offender treatment is needed not only to protect potential victims but also offenders themselves. Copyright © 2015 John Wiley & Sons, Ltd.

Bullying by peers in childhood and effects on psychopathology, suicidality, and criminality in adulthood.

Bullying is shown to be associated with adverse outcomes in cross-sectional studies, but only a few studies have prospectively examined the effects of childhood bullying on adult outcomes. Our Series paper focuses on prospective longitudinal studies that used large, population-based, community samples analysed through quantitative methods and published between 1960 and 2015. We describe the results of childhood bullying in adulthood in three of the most burdensome areas: psychopathology, suicidality, and criminality. We note that the different groups involved (ie, victims, bullies, and bully-victims) are at risk of difficulties later in life, but their risk profiles differ and the contributions are probably not independent. Controlling for confounders reduces the risk and sometimes eliminates it. Victims are at a high risk of internalising disorders. Bullies seem to be at risk of later externalising disorders and criminality, mainly violent crime and illicit drug misuse. Bully-victims seem to be at risk of internalising disorders, externalising disorders, and criminality, but not all studies examined bully-victims as a separate group. Boys and girls differ in their long-term outcomes. A dose effect exists in which frequent bullying involvement in childhood is most strongly associated with adult adversities. Future studies need to control for additional factors (including genetic, psychosocial, and environmental) to account for the mechanisms behind the reported longitudinal associations.

Separate and interactive contributions of weak inhibitory control and threat sensitivity to prediction of suicide risk.

Biobehavioral dispositions can serve as valuable referents for biologically oriented research on core processes with relevance to many psychiatric conditions. The present study examined two such dispositional variables-weak response inhibition (or disinhibition; INH-) and threat sensitivity (or fearfulness; THT+)-as predictors of the serious transdiagnostic problem of suicide risk in two samples: male and female outpatients from a U.S. clinic (N=1078), and a population-based male military cohort from Finland (N=3855). INH- and THT+ were operationalized through scores on scale measures of disinhibition and fear/fearlessness, known to be related to DSM-defined clinical conditions and brain biomarkers. Suicide risk was assessed by clinician ratings (clinic sample) and questionnaires (both samples). Across samples and alternative suicide indices, INH- and THT+ each contributed uniquely to prediction of suicide risk-beyond internalizing and externalizing problems in the case of the clinic sample where diagnostic data were available. Further, in both samples, INH- and THT+ interactively predicted suicide risk, with individuals scoring concurrently high on both dispositions exhibiting markedly augmented risk. Findings demonstrate that dispositional constructs of INH- and THT+ are predictive of suicide risk, and hold potential as referents for biological research on suicidal behavior.

Criminal offending among males and females between ages 15 and 30 in a population-based nationwide 1981 birth cohort: results from the FinnCrime Study.

We describe the epidemiology of crime between ages 15 and 30 in a population-based sample. We received police register data for 5405 males and females, representing the children born in Finland in 1981. We classified crimes into drug, violent, property, traffic, drunk driving, and sexual crimes, excluding minor traffic offenses. Of males, 60% and of females, 25% were registered for offending. For males, prevalence peaked in late adolescence, while for females, there was no peak age. Offending frequency remained stable for male offenders but was lower among adolescent female offenders. All crime types overlapped each other. Crime accumulated: 1% committed 34% of male and 56% of female offenses. In conclusion, the adolescent peak in offending reflects peaking prevalence among males, not females, nor frequency of offending among offenders. The crime problem is focused on two key groups: late adolescent males and the few males and females in whom crime concentrates.

Distinct variants of extreme psychopathic individuals in society at large: evidence from a population-based sample.

This study used model-based cluster analysis to identify subtypes of men who scored high in overall psychopathy (i.e., ≥ 95th percentile on the Triarchic Psychopathy Measure; n = 193) from a larger sample evaluated for service in the Finnish military (N = 4043). Cluster variates consisted of scores on distinct facets of psychopathy together with a measure of negative affectivity. The best-fitting model specified 2 clusters, representing "primary" (n = 110) and "secondary" psychopathy (n = 83) groups. Compared to a low-psychopathy comparison group (n = 1878), both psychopathy subgroups showed markedly elevated levels of externalizing symptoms and criminal behavior. Secondary psychopathic participants also reported high levels of internalizing problems including anxiousness, depression, and somatization, and scored higher on the disinhibition facet of psychopathy relative to the primary group. By contrast, primary psychopathic individuals reported fewer internalizing problems than either the secondary psychopathy or comparison groups and scored higher on the boldness facet of psychopathy. Primary psychopathic participants also had higher rates of violent crimes than the secondary psychopaths. Implications for conceptualizing and studying psychopathy in nonforensic populations are discussed.

What is the long-term outcome of boys who steal at age eight? Findings from the Finnish nationwide "From A Boy To A Man" birth cohort study.

OBJECTIVE: The aim was to study predictive associations between childhood stealing behavior at the of age 8 years with later psychiatric disorders, criminality or suicide attempts and completed suicides up to the age 25 years in a large representative population-based birth cohort. METHOD: The sample includes 2,592 Finnish males born in 1981 with information about stealing from both parents and teachers. Information about psychiatric disorders, criminality, suicide attempts requiring hospital admission and completed suicides was gathered from four different Finnish nationwide registries until the study participants were 25 years old. RESULTS: One out of ten boys had stealing behavior during the previous 12 months. After adjusting for parental education level and conduct problems or hyperactivity (i.e. potential confounds), stealing at eight independently predicted substance use and antisocial personality disorders, and high level of crimes. Stealing was also associated with completed suicide or severe suicide attempt requiring hospital admission. Comorbid stealing and frequent aggression had the strongest predictive association with any psychiatric diagnosis, crime and completed suicide or severe suicide attempt, while stealing without aggression was not associated with any of the negative outcomes. CONCLUSIONS: Stealing accompanied with aggressivity at age eight is predictive of wide range of adversities. However, no increased risk was observed among the group with stealing behaviors but without aggression.

Bullying at age eight and criminality in adulthood: findings from the Finnish Nationwide 1981 Birth Cohort Study.

CONTEXT: There are no prospective population-based studies examining predictive associations between childhood bullying behavior and adult criminality. OBJECTIVE: To study predictive associations between bullying and victimization at age eight and adult criminal offenses. DESIGN: Nationwide birth cohort study from age 8 to 26 years. PARTICIPANTS: The sample consists of 5,351 Finnish children born in 1981 with information about bullying and victimization at age eight from parents, teachers, and the children themselves. MAIN OUTCOME MEASURES: National police register information about criminal offenses at age 23-26 years. RESULTS: When controlled for the parental education level and psychopathology score, bullying sometimes and frequently independently predicted violent (OR 3.9, 95% CI 1.9-7.9, p < 0.001; OR 2.5, 95% CI 1.6-4.1, p < 0.001, respectively), property (OR 2.3, 95% CI 1.2-4.7, p < 0.05; OR 1.7, 95% CI 1.1-2.7, p < 0.05), and traffic (OR 2.8, 95% CI 1.8-4.4, p < 0.001; OR 1.6, 95% CI 1.3-2.1, p < 0.001) offenses. The strongest predictive association was between bullying frequently and more than five crimes during the 4-year period (OR 6.6, 95% CI 2.8-15.3, p < 0.001) in adjusted analyses. When different informants were compared, teacher reports of bullying were the strongest predictor of adult criminality. In adjusted analyses, male victimization did not independently predict adult crime. Among girls, bullying or victimization at age eight were not associated with adult criminality. CONCLUSIONS: Bullying among boys signals an elevated risk of adult criminality.

Generic and crime type specific correlates of youth crime: a Finnish population-based study.

OBJECTIVE: The aim of this study was to examine the psychosocial correlates of various crime types among adolescent males born in Finland in 1981. METHODS: Data on crime registered in the Finnish National Police Register between 1998 and 2001 were received for 2,866 boys, of whom 81% (n = 2,330) filled in a questionnaire at obligatory military call-up at age 18 in 1999. Crime was divided into five types: drug, violent, property, traffic, and drunk driving offences. RESULTS: Of the 2,866 boys, 23% had been registered for offending; 4% for drug, 7% for violent, 11% for property, 11% for traffic, and 5% for drunk driving offences during the 4-year period in late adolescence. All the crime types correlated with each other and shared many of the psychosocial problems. Small community size, parents' divorce, aggressiveness, daily smoking, and weekly drunkenness were generic correlates of crime, being independently related to various crime types. CONCLUSIONS: The results support general rather than specific accounts of youth crime. In particular, measures moderating the adverse effects of divorce, alleviating parental adversities and supporting parenthood, and tackling substance abuse seem relevant in social and criminal policy because they address psychosocial problems characterizing youth crime in general.

Psychosocial correlates of police-registered youth crime. A Finnish population-based study.

This study is focused on psychosocial correlates of youth crime in a sample of 2330 Finnish boys born in 1981. Two kinds of data were combined: questionnaires completed by the boys at call-up in 1999 and crime registered in the Finnish National Police Register between 1998 and 2001. One-fifth of the boys were registered to offending during the 4-year period in late adolescence; 14% were registered for one or two offences, 4% for three to five offences, and 3% for more than five offences. Crime accumulated heavily in those with more than five offences, as they accounted for 68% of all crime. Independent correlates of crime were living in a small community, parents' low educational level and divorce, having a regular relationship, self-reported delinquency, daily smoking, and weekly drunkenness, whereas anxious-depressiveness was reversely associated with crime. Most psychosocial problems covaried linearly with offending frequency, being particularly manifested by multiple recidivists. However, recidivists had very rarely used mental health services. The results indicate that offending and various psychosocial problems accumulate in a small minority of boys not reached by mental health services.

What predicts illicit drug use versus police-registered drug offending? Findings from the Finnish "From a Boy to a Man" birth cohort study.

AIMS: To study whether drug offenders differ in childhood and in early adulthood from those who only report using illicit drugs. DESIGN: Prospective nationwide birth cohort study. Baseline survey in 1989, follow-up data collection from self-reports, police and military registers in late adolescence and early adulthood. PARTICIPANTS: Two-thousand nine hundred and forty six Finnish boys born in 1981. Information about self-reported drug use at age 18 or police-registered drug offending at age 17-20 was available from 79.3% (n = 2,336) of the subjects. MEASUREMENTS: At age 8, psychopathology was assessed using the parent and teacher Rutter scales and child self-reports (Child Depression Inventory). ICD-10 psychiatric diagnoses at early adulthood according to the military register were based on a medical examination. FINDINGS: Childhood psychopathology did not predict self-reported drug use at age 18. Both conduct and hyperactivity problems at age 8 predicted drug offences at age 16-20. The predictive association with drug offences was strongest with severe level (over 90th percentile cut-off point) of conduct (OR 5.5, 95% CI 2.9-10.5) and hyperactivity problems (OR 5.0, 95% CI 2.7-9.3). Also moderate level of conduct (OR 2.9, 95% CI 1.7-4.9) and hyperactivity problems (OR 3.1, 95% CI 1.9-5.1) predicted drug offending. Having a psychiatric diagnosis in early adulthood associated with both self-reported use (OR 4.1, 95% CI 2.4-6.8) and drug offending (OR 13.2, 95% CI 8.3-21.2). CONCLUSIONS: Drug offending is part of a life-course-persistent deviance, whereas for self-reporters, psychiatric problems arise later in life. Accordingly, the preventive needs, and the age period for intervention are different for boys with divergent illicit drug use involvement.

Who is at greatest risk of adverse long-term outcomes? The Finnish From a Boy to a Man study.

OBJECTIVE: To study associations between comorbid psychopathology and long-term outcomes in a large birth cohort sample from age 8 to early adulthood. METHOD: The sample included long-term outcome data on 2,556 Finnish boys born in 1981. The aim was to study the impact of early childhood psychopathology types (externalizing versus internalizing versus both) and informant sources (self-report versus parent/teacher reports) on young adult outcomes, based on data from a military registry of psychiatric diagnosis, a police registry on criminal and drug offenses, and self-reported problems in late adolescence and early adulthood. RESULTS: Children with combined conduct and internalizing problems at age 8 had the worst outcomes and highest risk of subsequent psychiatric disorders, criminal offenses, and self-reported problems at follow-up, with 62% of these boys manifesting psychiatric disorders, committing criminal offenses, or both at follow-up. Although these children included only 4% of the sample, they were responsible for 26% of all criminal offenses at follow-up. In contrast, children with conduct problems without internalizing problems and those with attention problems had much less severe but nonetheless elevated levels of risk of antisocial personality disorder and criminal offenses. Long-term outcomes for these two groups were substantially better than for children with combined conduct and internalizing problems. Children with "pure" emotional problems had an elevated risk only of similar emotional problems at follow-up. CONCLUSIONS: The subjective suffering and long-term burden to society is especially high among children with comorbid conduct and internalizing problems in childhood. A major challenge for child and adolescent psychiatric, education, and social services is to develop effective intervention strategies focusing on these children. Additional longitudinal epidemiological studies of this comorbidity group are needed, and, if replicated, such findings will have important implications for future diagnostic classification systems (DSM-V).