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BMC Public Health. 2012; 12: 38.
Published online Jan 17, 2012. doi:  10.1186/1471-2458-12-38
PMCID: PMC3329420
Mortality and causes of death among violent offenders and victims-a Swedish population based longitudinal study
Marlene Stenbacka,corresponding author1,2 Tomas Moberg,3 Anders Romelsjö,2 and Jussi Jokinen3
1Addiction Center Stockholm, Karolinska University Hospital Solna, Building Z8, 171 76 Stockholm, Sweden
2Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Norrbacka Building, 171 76 Stockholm, Sweden
3Department of Clinical Neuroscience, Karolinska Institute, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden
corresponding authorCorresponding author.
Marlene Stenbacka: marlene.stenbacka/at/sll.se; Tomas Moberg: tomas.moberg/at/ki.se; Anders Romelsjö: anders.romelsjo/at/ki.se; Jussi Jokinen: jussi.jokinen/at/sll.se
Received September 2, 2011; Accepted January 17, 2012.
Abstract
Background
Most previous studies on mortality in violent offenders or victims are based on prison or hospital samples, while this study analyzed overall and cause specific mortality among violent offenders, victims, and individuals who were both offenders and victims in a general sample of 48,834 18-20 year-old men conscripted for military service in 1969/70 in Sweden.
Methods
Each person completed two non-anonymous questionnaires concerning family, psychological, and behavioral factors. The cohort was followed for 35 years through official registers regarding violent offenses, victimization, and mortality. The impact of violence, victimization, early risk factors and hospitalization for psychiatric diagnosis or alcohol and drug misuse during follow up on mortality was investigated using Cox proportional hazard regression analyses.
Results
Repeat violent offenses were associated with an eleven fold higher hazard of dying from a substance-related cause and nearly fourfold higher hazard of dying from suicide. These figures remained significantly elevated also in multivariate analyses, with a 3.03 and 2.39 hazard ratio (HR), respectively. Participants with experience of violence and inpatient care for substance abuse or psychiatric disorder had about a two to threefold higher risk of dying compared to participants with no substance use or psychiatric disorder.
Conclusions
Violent offending and being victimized are associated with excess mortality and a risk of dying from an alcohol or drug-related cause or suicide. Consequently, prevention of violent behavior might have an effect on overall mortality and suicide rates. Prevention of alcohol and drug use is also warranted.
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