Objective:

To assess whether teacher-rated emotional, behavioural and social difficulties at ages 6–12 were associated with hospitalisation or death from alcohol-related disease, drug-related disease or intentional self-harm between ages 18 and 40.

Approach:

• Design and participants: Population-based cohort study using 5,290 participants from the Québec Longitudinal Study of Kindergarten Children, with linked health records.
• Measures and analysis: Teachers assessed disruptive behaviours, ADHD symptoms, emotional distress and prosociality. Cox models adjusted for sex, age and parental socioeconomic characteristics.

Key Findings:

• By age 40, 249 participants (4.7%) had experienced hospitalisation or death from a disease of despair: 183 drug-related, 110 alcohol-related and 37 intentional self-harm outcomes.
• Each 1-SD increase in overall childhood emotional, behavioural and social problems was associated with a higher hazard of diseases of despair (adjusted HR 1.49, 95% CI 1.32–1.68).
• Disruptive behaviours and ADHD symptoms were associated with higher hazards (adjusted HRs 1.39 and 1.44, respectively); prosociality was associated with a lower hazard (adjusted HR 0.81, 95% CI 0.71–0.93).
• Associations were concentrated largely in alcohol- and drug-related diseases. Disruptive-behaviour associations were stronger among females (interaction P=0.040).

Interpretation:

The authors report that teacher-assessed childhood socioemotional difficulties were associated with later hospitalisation or mortality from diseases of despair, particularly alcohol- and drug-related outcomes.

Limitations:

• The supplied context does not provide the full limitations section, so specific study limitations cannot be summarized.

Conclusion:

The authors state that intervention studies are needed to assess whether changing these childhood capacities lowers later risk.