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Who Is at Greatest Risk of Adverse Long-Term Outcomes? The Finnish From a Boy to a Man Study

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ABSTRACT

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).

Section snippets

CHALLENGES IN CONDUCTING LONG-TERM OUTCOME STUDIES

There are several vexing methodological issues to consider when interpreting results from longitudinal studies of developmental psychopathology. First, how should one decide on appropriate methods for integrating reports from different sources (Kraemer et al., 2003a)? Low agreement among parents, teachers, and children about the presence of childhood emotional and behavioral problems or impairment in clinical and community settings is well documented (Achenbach et al., 1987, Bird et al., 1992,

ADDRESSING COMPLEXITY

Once we acknowledge the complexity of many possible combinations of symptoms, disorders, and informants that may in fact not be additive, the analytical challenges of exploring an unmanageable number of possible interactive combinations are statistically overwhelming. A parsimonious approach to managing this complexity, in the service of understanding psychopathology and its long-term outcomes, is needed.

Empirically based taxonomies of child psychopathology have yielded two broad dimensions of

Subjects

This investigation is a part of the nationwide “From a Boy to a Man” study, a follow-up study included in the Epidemiological Multicenter Child Psychiatric Study in Finland (Almqvist et al., 1999). The study design and methods have been described more extensively in previous reports in this journal (Sourander et al., 2004a, Sourander et al., 2004b, Sourander et al., 2005, Sourander et al., 2006). The original study sample was drawn from the total population of Finnish children born during 1981 (

Psychopathology Group Types and Cross-Sectional Associations at Age 8

The C-E group included 110 boys (4.3% of the sample), the conduct-only group 147 boys (5.8%), the attention group 102 boys (4.0%), the emotional-only group 245 boys (9.6%), and the invisible group 166 boys (6.5%). Table 1 shows the sample's descriptive characteristics and results of logistic regression and NNT analysis including family structure, parental education level, reported need for help, and psychopathology group types.

DISCUSSION

To the best of our knowledge, this is the first report of a representative sample of boys' long-term outcomes in young adulthood that captures psychiatric diagnoses, extensive data concerning functioning from universal military and criminal registries, and self-report information. As such, the present study has a number of significant strengths. Findings are derived from a community-based study sample representative of the target population, and the study design was a prospective follow-up

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    • Cited by (0)

    This study was supported by the Sigrid Juselius Foundation, Yrjo Jahnsson Foundation, Finnish Defence Forces (MATINE), and Signe and Arne Gyllenberg Foundation.

    Article Plus (online only) materials for this article appear on the Journal's Web site: www.jaacap.com

    Disclosure: Dr. Jensen has received research funding from McNeil; has received unrestricted grants from Pfizer; has consulted to Best Practice, Inc., Shire, Janssen, Novartis, and UCB; and has participated on the speakers' bureaus of Janssen-Ortho, Alza, McNeil, UCB, CME Outfitters, and the Neuroscience Education Institute. Dr. Jensen also owns shares in Eli Lilly. The other authors have no financial relationships to disclose.

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    Copyright © 2007 The American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.