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.


METHODS
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).
Sourander
Andre
A
Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.. Electronic address: andre.sourander@utu.fi.
Jensen
Peter
P
Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
Davies
Mark
M
Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
Niemelä
Solja
S
Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
Elonheimo
Henrik
H
Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
Ristkari
Terja
T
Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
Helenius
Hans
H
Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
Sillanmäki
Lauri
L
Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
Piha
Jorma
J
Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
Kumpulainen
Kirsti
K
Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
Tamminen
Tuula
T
Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
Moilanen
Irma
I
Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
Almqvist
Fredrik
F
Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000987:Antisocial Personality Disorder / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D019955:Conduct Disorder / Q000453:epidemiology / Q000523:psychology; D003415:Crime / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology*; D012307:Risk Factors; D011795:Surveys and Questionnaires