Childhood Problem Behaviors and Death by Midlife: The British National Child Development Study

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Abstract

Objective

To examine childhood problem behaviors manifested as externalizing behaviors (e.g., aggression, impulsivity) and internalizing behaviors (e.g., anxiousness, avoidant behavior) as predictors of mortality by the age of 46 years and to assess whether these associations are dependent on childhood family background.

Method

The participants were 5,426 girls and 5,716 boys born in 1958 and participants in the British National Child Development Study (total N = 11,142). Childhood problem behaviors were assessed by teachers at ages 7 and 11 years, and the participants were followed for mortality to the age of 46 years.

Results

Both externalizing and internalizing behaviors were associated with mortality in adulthood. By the age of 46 years, the cumulative probabilities of death by increasing externalizing score quartiles were 1.4%, 2.2%, 2.3%, and 3.2%, respectively (odds ratio [OR] for mortality per 1 SD increase in standardized externalizing score 1.27; 95% confidence interval [Cl] 1.13–1.44). The corresponding percentages for internalizing score quartiles were 1.8%, 1.9%, 2.3%, and 3.0% (OR 1.20; 95% Cl 1.06–1.35). Adjusting for father's social class, family difficulties, family size, and cognitive ability attenuated these associations for externalizing behaviors (OR 1.21; 95% Cl 1.06–1.37) and for internalizing behaviors (OR 1.11; 95% Cl 0.98–1.26). Childhood environment did not modify the association between problem behaviors and mortality.

Conclusions

Childhood problem behaviors are associated with increased long-term mortality risk beyond childhood and adolescence.

Section snippets

Participants

The British National Child Development Study (also known as the 1958 British birth cohort) was launched in 1958.18, 19 The original participants were 17,634 individuals born in England, Wales, and Scotland during 1 week in March 1958. After the study baseline at the time of birth, data have been collected in follow-up phases at 7, 11, 16, 23, 33, 42, and 46 years of age. In the present study, we included all 11,142 participants (5,716 boys and 5,426 girls; representing 63% of the original

Results

Table 1 shows the correlations between childhood problem behaviors, childhood environments, and cognitive ability. Externalizing and internalizing behaviors were positively correlated with each other (r = 0.38), and they were both associated with adverse family environment and with low cognitive ability (Table 1). Table 2 shows the association between childhood covariates and mortality risk. As expected, in unadjusted models, high mortality risk was predicted by male sex, low social class, high

Discussion

In a large British birth cohort, childhood externalizing and internalizing behaviors predicted increased mortality between 11 and 46 years of age so that individuals with high problem behaviors in childhood had a heightened mortality risk even in adulthood. There were no interaction effects between problem behaviors and measures of childhood environment, implying that adverse childhood environment did not modify the role of problem behaviors in predicting mortality risk. The findings provide

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    This study was financially supported by the Academy of Finland (grant no. 124322 and 117604).

    This article is the subject of an editorial by Dr. Adrian Angold in this issue.

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