US juveniles with conduct problems face high risk of premature death

Peer reviewed: Yes
Type of study: Non-randomised comparative study
Subject of study: People
Funding: Government/research council

We already know that adolescents with conduct and/or substance use problems are at increased risk for premature death, mainly from substance-related deaths, traffic accidents, and violent deaths (related to suicide, assault, or legal intervention). This prospective study of more than 3700 US juveniles discovered that there is an independent association between conduct disorder and mortality hazard.   In other words, the connection between conduct disorder and risk of early death appears to exist even when other contributing factors such as sex, ethnicity, familial factors, and substance use are removed. 

This is important because conduct disorder can be treated and improved, potentially reducing the risk of early death. 

And the risk is substantial.  This study followed 1463 US youths with combined conduct disorder (CD) and substance use disorder (SUD), 1399 of their siblings, and 904 community controls.  It found that the relative risk of mortality among the first two groups was 4.99 times higher than the controls.  Over an average follow-up time of 16 years, 96 deaths were observed among adolescents with CD/SUD and their siblings versus 8 deaths among controls.

The study used the definition of conduct disorder provided by the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV): “A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated,” which includes aggression toward people and animals, property destruction, deceitfulness or theft, and serious violation of rules.

Lead author Richard Border (University of Colorado Boulder) adds this caveat: “Because this study focused on juveniles with severe CD and SUD, the extent to which the results might generalize to individuals with moderate CD and SUD is unclear.  But our results indicate that adolescents with severe CD are at marked risk for premature death beyond that which can be explained by substance use problems and sociodemographic factors, which should make them a prime target for future treatment research.”

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For editors:

This paper is free to download from the Wiley Online Library: or by contacting Jean O’Reilly, Editorial Manager, Addiction,, tel +44 (0)20 7848 0853.

Interviews with lead author Richard Border: contact him at the University of Colorado Boulder by email ( or telephone (+1 303 492 7362).

Full citation for article: Border R, RP Corley, SA Brown, JK Hewitt, CJ Hopfer, SK McWilliams, SA Rhea, CL Shriver, MC Stallings, TL Wall, KE Woodward, and SH Rhee (2018) Independent predictors of mortality in adolescents ascertained for conduct disorder and substance use problems, their siblings, and community controls.  Addiction 110: doi: 10.1111/add.14366.

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.