Mortality of young offenders: a national register-based follow-up study of 15- to 19-year-old Finnish delinquents referred for forensic psychiatric examination between 1980 and 2010

Abstract

BackgroundThe mortality rate of young offenders is high. Furthermore, mortality in young offenders is associated with psychiatric and substance use disorders. The primary aim of this national register-based follow-up study was to investigate the mortality rate of Finnish delinquents who underwent a forensic psychiatric examination between 1980 and 2010. As delinquency is not a solid entity, we further aimed to compare the risk of premature death among different subgroups of the delinquents; violent versus non-violent offenders, offenders with alcohol use disorders versus those with no such diagnoses, offenders with schizophrenia spectrum disorders versus conduct- and personality-disordered offenders, under-aged versus young adult offenders, and, finally, boys versus girls.MethodsWe collected the forensic psychiatric examination reports of all 15- to 19-year-old offenders who were born in Finland and had undergone the examination between 1.1.1980 and 31.12.2010 (n = 606) from the archives of the National Institute of Health and Welfare and retrospectively reviewed them. For each delinquent, four age-, gender- and place of birth-matched controls were randomly selected from the Central Population Register (n = 2424). The delinquents and their controls were followed until the end of 2015. The median follow-up time was 23.9 years (interquartile range 15.3–29.5). We obtained the mortality data from the causes of death register. Deaths attributable to a disease or an occupational disease were considered natural, and those attributable to an accident, suicide or homicide were considered unnatural.ResultsBy the end of the follow-up period, 22.1% (n = 134) of the delinquents and 3.4% (n = 82) of their controls had died (OR 8.11, 95% CI 6.05–10.86, p < 0.001). Among boys, 22.0% (n = 121) of the delinquents and 3.7% (n = 81) of the controls had died (OR 7.38, 95% CI 5.46–9.95, p < 0.001). Male delinquents’ risk of unnatural death was almost 11-fold, of natural death more than twofold, and of unclear death more than fourfold compared to that of their controls. No girls had natural or unclear deaths, but 23.6% (n = 13) of the delinquents and 0.5% (n = 1) of the controls had died due to unnatural causes (OR 67.79, 95% CI 8.63–532.00, p < 0.001). The violent delinquents’ risk of premature death was twice that of the non-violent delinquents. The other comparisons demonstrated no statistically significant differences between subgroups.ConclusionsEven though the Finnish correction system prefers psychiatric treatment and rehabilitation over criminal sanctions, and the national health care system offers developmental-phase-specific psychiatric care, the mortality rate of delinquents, especially of those with a history of violent offences, is high. The excess mortality of offenders can be regarded as a specific public-health inequity that calls for more effective intervention procedures than those used thus far.

Do Criminals Live Faster Than Soldiers and Firefighters?

“…Although all these models can account for some cases of premature deaths among offenders, many recent studies have indicated a lack of direct connection between early mortality and breaking the law (Tremblay and Paré 2003;van de Weijer et al 2016;Zane et al 2018). Most of all, compared with the general population, offenders are more likely to die from unnatural causes (Chen et al 2010;Elonheimo et al 2017) such as accidents (Lindberg et al 2017;Rosen et al 2008;Zane et al 2018), suicide (Björk and Lindqvist 2005;Lindqvist et al 2007), and as a result of substance abuse (Bukten et al 2017;Forsyth et al 2014). Moreover, an analysis of data obtained from the National Longitudinal Study of Adolescent Health has shown that adolescents with a pessimistic outlook on their life expectancy are more likely to engage in criminal activity later in life (Nedelec and Beaver 2012).…”

“…The tendency to engage in criminal activity is commonly associated with low life expectancy (Aalsma et al 2016 ; Lindberg et al 2017 ). There are three models of explanation for premature mortality among offenders that are not mutually exclusive (van de Weijer et al 2016 ).…”

“…According to life history (LH) theory, a high level of extrinsic morbidity-mortality that elevates the risk of dying prematurely, in that it is unlikely to be avoided by action undertaken by an individual, favors fast LH strategies (Del Giudice et al 2015 ; Ellis et al 2009 ). Compared with the general population, both criminal offenders and men working in dangerous professions tend to experience higher rates of morbidity-mortality (Elonheimo et al 2017 ; Fisher et al 2017 ; Lindberg et al 2017 ; Ma et al 2005 ), so they might be viewed as more likely to employ fast LH strategies. However, one of the most common motivations among risk-taking professionals is prosocial concern (Firmin et al 2018 ; Woodruff et al 2006 ), considered to be a component of a slow LH strategy (Rushton 1990 ; Sherman et al 2013 ).…”

Violence-Related Death in Young Australians After Contact With the Youth Justice System: A Data Linkage Study

“…Beyond the Unites States, little is known on the risk of dying from violence among justice-involved young people. Similar to trends in the general population (Grinshteyn & Hemenway, 2016), studies conducted in Australia (Coffey et al, 2004) and Finland (Lindberg et al, 2017;Sailas et al, 2006) found that a lower proportion of young people released from detention died from violence (3%-16%) compared to U.S.-based studies (48%-68%) (Aalsma et al, 2016;Ezell & Tanner-Smith, 2009;Teplin et al, 2014). Our previous study found that violence-related deaths among justice-involved young people in Australia often involved a weapon, were preceded by an altercation for men and a relationship breakdown for women, and had cannabis and/or alcohol present in the toxicology reports of the death (Willoughby et al, 2021).…”

Education, Policy, and Juvenile Delinquents: A Mixed Methods Investigation During COVID-19

“…Juvenile delinquents have, as a group, a long history of low academic achievement and an incongruent, poorly reflected appraisal (Blomberg & Pesta, 2017;Walters, 2020). Much higher rates of mental illness compounded the problem of poor educational attainment (Lindberg et al, 2017). Once released, juvenile delinquents have behavioral problems in school and a much higher rate of dropping out of high school (Benner et al, 2016;Jaggers et al, 2016).…”