University of Oulu

Lindberg et al. Child Adolesc Psychiatry Ment Health (2017) 11:37, DOI 10.1186/s13034-017-0174-3

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

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Author: Lindberg, Nina1; Miettunen, Jouko2,3; Heiskala, Anni2;
Organizations: 1Forensic Psychiatry, Helsinki University and Helsinki University Hospital
2Center for Life Course Health Research, University of Oulu
3Medical Research Center Oulu, Oulu University Hospital and University of Oulu
4School of Medicine, Tampere University
5Department of Adolescent Psychiatry, Tampere University Hospital
6Vanha Vaasa Hospital
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
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Language: English
Published: Springer Nature, 2017
Publish Date: 2017-10-10


Background: The 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.

Methods: We 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.

Results: By 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.

Conclusions: Even 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.

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Series: Child and adolescent psychiatry and mental health
ISSN: 1753-2000
ISSN-E: 1753-2000
ISSN-L: 1753-2000
Volume: 11
Issue: 37
DOI: 10.1186/s13034-017-0174-3
Type of Publication: A1 Journal article – refereed
Field of Science: 3124 Neurology and psychiatry
Funding: This study was funded by the Helsinki and Uusimaa Hospital District.
Dataset Reference: The data contributing to these analyses are stored in a secure database at Helsinki University, Department of Psychiatry, in accordance with European data-protection legislation. Researchers and clinicians seeking access to these data for academic non-commercial purposes are welcome to submit a request to the corresponding author (NL). All such requests will be granted whenever possible.
Copyright information: © The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.