Adolescents in a residential school for behavior disorders have an elevated mortality risk in young adulthood

Conduct problems during adolescence are associated with an elevated mortality risk. This study investigated the mortality rate, causes of death, and changes over time in a Finnish residential school (RS) population.

All adolescents (N = 885, M/F = 594/291, age mean 15.2 years at baseline) residing in the RS system in 1991, 1996, 2001, and 2006 and matched controls were included in a register-based study with a follow-up time of up to 22 years.

The all-cause mortality rate for people with an RS background was 6.7 % compared to 1.0 % in the controls (Hazard Ratio HR = 6.95, 95 % 4.66-10.37, p < 0.001). 8.1 % of the RS boys had died compared to 2.2 % of the girls (HR = 2.2, p = 0.02). The HR for substance-related death was 24.31 (95 % CI 9.3-65.53, P < 0.001), for suicide 7.23 (95 % CI 3.24-16.11, P < 0.001) and for other external causes 5.45 (95 % CI 2.41-12.36, P < 0.001) compared to controls. Mortality peaked among RS boys at approximately 25 years, whereas for girls it peaked after 30 years.

Adolescents with severe disruptive behavior problems have a seven-fold risk for premature adult-age death compared to matched controls. The most common causes for death were avoidable, substance-related followed by suicide. Effective treatment of mental and substance use related problems during and after the placement is needed to reduce mortality.