Background
Family psychosocial characteristics such as criminality, alcohol abuse, and mental problems are important to understand later criminal behaviour and premature death [
1‐
5]. Most studies have, however, focused on male populations leaving it unclear whether these findings are also applicable to females. Moreover, there is a paucity of knowledge from longitudinal studies about individual factors that could possibly mediate these associations. The purpose of the present study is to examine gender differences in the influences of a variety of family psychosocial characteristics on the child's subsequent criminal behaviour and mortality and to see whether these influences could be mediated through different individual factors in the child.
Previous research has indicated that children from alcoholic families are at serious risk for developing various forms of problems as adults [
6]. Already in an early follow-up study, the children of alcoholic fathers became criminals more often than other children [
7]. A register-based study of about 84,800 adolescents and young adults in Denmark, covering the age period of 15-27 years, reported that parental alcohol abuse may influence several long-term consequences, such as increased self-destructive behaviours including drug addiction, hospitalization due to violence, and mortality [
8]. Another study demonstrated that maternal and paternal alcohol use behaviours were positively linked with children's alcohol use behaviours at 14 and 171/2 years of age, among both genders [
2]. Furthermore, a longitudinal study of Swedish male conscripts reported that there is a clear association between fathers' consumption patterns and their own alcohol consumption as well as risk of early death [
9].
Children of parents who abuse alcohol or other drugs are moreover found to have higher rates of emotional problems [
10]. Even for young children parental alcohol abuse, especially among fathers, has shown to be associated with negative effects as evidenced in subsequent anxiety/depression symptoms influenced via greater levels of marital aggression [
11]. A cross-sectional study on a large group of medical students confirmed that there is a strong relationship among parental alcoholism, adverse childhood experience, and subsequent personal alcohol abuse [
12]. The results of a study on the impact of adverse childhood experiences on a wide variety of health behaviours and outcomes, showed that adults who grew up with both an alcohol-abusing mother and father had the highest likelihood of multiple forms of adverse childhood experiences, such as abuse, neglect, and other household dysfunctions as compared to those who had only one- or no alcohol-abusing parent [
13].
Furthermore, in a 33-year longitudinal study of children of alcoholics, non-delinquent sons of alcoholic men (COA's) had more alcoholic relatives, more environmental stress, more emotional and medical problems, and poorer adjustments than their non-COA peers [
14]. However, the COA's did not demonstrate poor results on intelligence tests, nor increased behaviour problems related to hyperactivity, otherwise found to be a strong predictor of both subsequent alcohol problems and violence [
15]. However, even if genes have a very strong impact on the development of substance abuse, there is an important interaction between genes and environmental influences in this process [
16,
17], as recently differently evidenced in male and female subjects [
18]. In a study of individuals with substance use disorders and their adult first-degree relatives, there was an eight-fold increased risk of illicit drug disorders among the relatives as compared to their control group counterparts [
19].
Generally, males are more likely to be at higher risk for early developed alcoholism, assumed to be more connected to biological and genetic factors, and distinguished from later developed alcoholism [
20,
21]. Early developed alcoholism is more frequently associated with additional problems like drug abuse and criminal behaviour than later developed alcoholism [
22,
21]. There are some indications of the existence of an early developed alcoholism related group also among female subjects [
23]. A possible explanation for differences in reported results/indications between males and females could be that the hereditary form of alcoholism phenotypically expresses itself differently in females, despite the fact that the underlying genetic vulnerability might be the same.
It has furthermore been reported that individuals with addiction disorders have a higher occurrence of psychiatric and personality disorders [
24]. This risk is nevertheless not equally distributed between the genders. While antisocial personality disorder dominates as the comorbid psychiatric diagnosis among alcohol dependent men, anxiety and depression are the most commonly reported diagnoses for women [
25,
26]. Studies have also shown a higher degree of alcoholism in families with a high degree of depression among women. To sum up, there seem to be differences concerning psychiatric comorbidity among alcohol-dependent- women and men.
An association between alcohol use or abuse and criminal behaviour, especially violent criminality, has also been reported in other groups [
27‐
31]. In adolescents, higher alcohol consumption and more problematic alcohol and drug use was found in those with violence and conduct problems [
32,
33]. Strong connections between family history of alcohol abuse and violent offending were evidenced in a study by Linnoila and collaborators [
34]. Notably, the vast majority of the offenders had committed crimes under the influence of alcohol.
Abused and neglected children, especially boys/males, had a higher likelihood of criminality, especially violence, compared with a control group with no experience of having been abused [
35,
36]. This is an important aspect in light of recent results reporting that many children have had an experience of living with parents having mental problems. A national survey in Canada that estimated the number of children exposed to parental psychiatric disorders, found that about 570,000 children under the age of 12 years were living with parents that had substance use, mood, or anxiety disorders [
37]. Children with parents having mental problems have been found to have a higher risk to develop substance abuse and mental illness. Several studies have stated that children of parents with depression or substance misuse are at a higher risk of developing the same condition as the parent [
38‐
42].
There is less research related to gender differences on the influences of family psychosocial characteristics [
8]. However, boys with alcoholic parents tend to have an increased risk for criminal behaviour [
6], and girls with maternal alcohol abuse and depression are found to have more serious mental problems than boys in the same situation [
43]. Among outpatient adolescents and their parents, psychiatric problems among parents were found in 66% of the cases. The most common mental problem among fathers reporting alcohol abuse was depression (1/3). Fathers with both depression and alcohol problems were more frequent among the outpatient adolescent boys (29%) than girls (5%) [
43].
Furthermore, a review of the effects of parental imprisonment on child antisocial behaviour and mental health showed that children of prisoners had about twice the risk of antisocial behaviour and poor mental health outcomes as compared to children whose parents were not imprisoned [
3]. With regard to mortality, parental social class may have an influence on early death. In a prospective longitudinal study of men, where the fathers had a working-class occupation, 5% had died by age 48, and early death was strongly linked with criminal behaviour already at age 8-10 years [
1]. In a study of offspring of mothers with psychotic disorders, females had lower all-cause mortality and mortality from unnatural causes than male subjects [
44].
There are relatively few studies on populations of at-risk children; the vast majority has focused on data from parents in treatment settings. One of the few studies that used population-based data, from the National Longitudinal Alcohol Epidemiological Survey, estimated that approximately one out of four American children under the age of 17 years were exposed to alcohol abuse or dependence in the family (lifetime) [
45]. Thus, there is a need for using large longitudinal databases for researching the underlying links between family lifestyle/characteristics and the development of criminal behaviour and mortality.
Aim and hypothesis of the present study
The overall aim of the present study was to examine the influences of family psychosocial characteristics on the child's subsequent criminal behaviour and mortality using longitudinal data from the Stockholm Birth Cohort study. Three explicit research questions were identified: first, how different family psychosocial characteristics in childhood, such as father's criminality and alcohol abuse, as well as parental mental problems, may influence children's development into criminal behaviour and mortality; second, whether these possible relationships could potentially be mediated by the individual's own alcohol and/or drug use and mental problems; and, third, whether there are differences in these possible patterns by gender.
Discussion
The aim of the present study was to investigate the association between family psychosocial characteristics and the individual's development into criminal behaviour and mortality. Three research questions were included: first, how different family psychosocial characteristics in childhood may influence children's development into criminal behaviour and mortality; second, potential mediation by the individual's own alcohol and/or drug use and mental problems; and, third, possible differences in these patterns by gender.
Influences on the outcome variable criminality
The different indicators of family psychosocial characteristics (father's criminality, father's alcohol abuse and parents' mental problems) were strongly associated with subsequent criminality in the male group in line with earlier research [
8,
49‐
51]. These associations might, apart from familial/genetic influences, also be interpreted as due to social modelling, as well as shared risk factors such as peer factors and individual features [
52,
53]. Among females, however, having a father abusing alcohol appeared to be more important for their criminal behaviour than the father's criminality, or either of the parents having mental problems. Worth noticing, these associations were also similar when only violent crimes were considered as the outcome (data not presented). These associations were largely unexplained by the occupational class during childhood. Interestingly, this is in line with earlier results from a Swedish study reporting the same influence of alcoholic fathers, comparing those from the highest- and lowest social class, on their children's development of juvenile delinquency [
54]. Furthermore, in the present study, both for males and females, statistically significant links between individual problems, in terms of alcohol and/or drug use as well as mental problems, and criminality were found. This is of special interest, since these individual problems in the present study covered the age period of 13-19 years, and thus indicate that early-onset alcohol problems were closely connected to criminal behaviour and a family history of alcohol abuse [
22]. Additionally, to some extent, these individual problems seemed to possibly mediate the association between family psychosocial characteristics and the individual's own subsequent criminality. It is noteworthy, however, that females' own alcohol and/or drug abuse overrode the effect of adverse family characteristics on criminality.
Influences on the outcome variable mortality
The present results further suggested that deaths in the age range of 28 to 56 years are more common among males whose fathers abused alcohol as compared to their male counterparts. No corresponding associations seemed to apply for father's criminality or mental problems in the parents. The results can be compared with findings from another study [
8] reporting parents' abuse of alcohol having consequences for their children (both males and females) during the age period of 15 to 27 years in terms of mortality and hospitalization due to violence. In the present study however, among females, parents' mental problems emerged as the most important of the family psychosocial characteristics investigated for the outcome of early death (this was the case regardless of whether these problems occurred in the mother or the father, data not presented). These are new findings and should be further studied. Childhood social class did not seem to confound this relationship to any large extent. With regard to individual problems, criminality (all crimes as well as violent crimes), alcohol and/or drug use, and, to a lesser extent, mental problems, contributed to parts of the explanation to the associations between family psychosocial characteristics and subsequent mortality. This was the case for both male and female subjects.
Strengths and limitations
The prospective design of the Stockholm Birth Cohort database permitted the study of development into criminal behaviour and mortality. Moreover, the richness of the data made it possible to include a variety of indicators of family psychosocial characteristics and individuals problems. The large-scale data material also enabled us to perform gender-specific analysis in order to examine whether the patterns of association studied differed for males and females. There are nevertheless some issues that need to be recognised. Firstly, although the longitudinal data allowed for temporal ordering of the variables, no inference about causality can be made. The pathways leading to criminal behaviour and, not the least, to mortality are multifaceted and involve a complex interplay between family psychosocial characteristics and individual problems in the developmental context. Secondly, given the explorative approach of the present study, the investigated indicators were defined in terms of relatively broad categories. Future studies should aim at investigating these aspects in more detail, as well as including other sets of explanatory factors such as intelligence, other school-related indicators, and personality factors. Thirdly, the outcomes were captured through a rather lengthy follow-up (14 years for criminality and 28 years for mortality). The types of criminality and cause of death were likely to vary by age, which could make it more complicated to disentangle the contributions of the family-related- and individual risk indicators studied to subsequent criminal behaviour and mortality. Finally, although attrition was very low in the analysis, the study sample contains some individuals whose families were not resident in the actual Stockholm area before 1963, and some individuals who could have moved (in and) out of the area after 1963. The prevalence of family-related characteristics and individual problems could thus have been underestimated, which is likely also to cause an underestimation of the magnitude of the relationships obtained.
Practical implications of the findings
The present study indicated that family psychosocial characteristics during childhood are associated with the child's subsequent criminal behaviour and mortality. To some extent, these influences appeared to operate through individual risk factors, such as alcohol and/or drug use and mental problems (for mortality also the risk factor of criminality). In order to give a more balanced picture, which reaches over and above the one that may be obtained by multivariate analysis, population attributable fractions were calculated. Results indicated that although the associations were strong, removing the exposure of father's alcohol abuse and criminality as well as parents' mental problems would not decrease the cases of criminality (a total decrease of 7.9% for males and 1.8% for females) or mortality (a total decrease of 1.2% for males as well as for females) to any large extent. Interestingly, however, having had no individual problems the incidence of criminality would have decreased greatly among males (a total decrease of 519 cases) or mortality (a total decrease of 53 cases), lesser so among the females (14 and 5 cases, respectively). Thus, the practical implications of the present study point to the importance of the individual's alcohol and/or drug use in reducing criminal behaviour, particularly among males. Moreover, any reduction in criminality would subsequently lower the mortality rates. This interpretation is however restricted to the framework of the current study. To eliminate the effect of adverse family psychosocial characteristics is still likely to be highly beneficial for other types of outcomes in the child, such as psychological well-being and school achievement, which in turn could have an impact on opportunities, achievements, and lifestyle in adulthood. Furthermore, there is still a substantial part of the development into criminal behaviour and subsequent mortality that remains unaccounted for by the risk factors included here. Thus, the findings of the present study should be considered in light of these arguments. It is also necessary to discuss whether our findings, as they are based on a Swedish cohort, are applicable to other settings. In comparison to many other countries, Sweden has a generous welfare system in part designed to compensate for unequal living conditions across social groups. This could possibly indicate that the safety net for individuals growing up in families with more adverse family psychosocial characteristics is more comprehensive compared to other cultural and societal settings.
Britt af Klinteberg, PhD, Professor of Psychology, Stockholm University, and affiliated Professor with the Department of Women's and Children's Health, Karolinska Institutet, Stockholm; Ylva Almquist, PhD, post doctoral researcher at CHESS, Stockholm University/Karolinska Institutet, Stockholm; Ulla Beijer, PhD, researcher at the Department of Women's and Children's Health, Karolinska Institutet, Stocholm; Per-Anders Rydelius, MD, PhD, Professor of Pediatrics, Department of Women's and Children's Health, Karolinska Institutet, Stockholm.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
BaK, the scientific leader of the project, conducted the preliminary design, participated in presenting the results, provided the supervision and the interpretation of data, drafting of the manuscript, and gave the final design and shape of the manuscript. YA was responsible for the statistical analysis, participated in the study design, presentation of the results and discussion, and drafting of the manuscript. UB participated in the study design, background, discussion, and drafting of the manuscript. P-AR conducted the preliminary design and contributed to the drafting of the manuscript. All authors have read and approved the final manuscript.