Predicting death in young offenders: a retrospective cohort study

Carolyn Coffey, Andrew W Lovett, Eileen Cini, George C Patton, Rory Wolfe and Paul Moran
Med J Aust 2004; 181 (9): 473-477.


Objective: To examine predictors of death in young offenders who have received a custodial sentence using data routinely collected by juvenile justice services.

Design: A retrospective cohort of 2849 (2625 male) 11–20-year-olds receiving their first custodial sentence between 1 January 1988 and 31 December 1999 was identified.

Main outcome measures: Deaths, date and primary cause of death ascertained from study commencement to 1 March 2003 by data-matching with the National Death Index; measures comprising year of and age at admission, sex, offence profile, any drug offence, multiple admissions and ethnic and Indigenous status, obtained from departmental records.

Results: The overall mortality rate was 7.2 deaths per 1000 person-years of observation. Younger admission age (hazard ratio [HR], 1.4; 95% CI, 1.0–1.9), repeat admissions (HR, 1.8; 95% CI, 1.1–2.9) and drug offences (HR, 1.5; 95% CI, 1.0–2.1) predicted early death. The role of ethnicity/Aboriginality could only be assessed in cohort entrants from 1996 to 1999. The Asian subcohort showed higher risk of death from drug-related causes (HR, 2.5; 95% CI, 1.1–5.5), more drug offences (relative risk ratio [RRR], 13; 95% CI, 8.5–20.0) and older admission age (oldest group v youngest: RRR, 9.3; 95% CI, 1.3–68.0) than non-Indigenous Australians. Although higher mortality was not identified in Indigenous Australians, this group was more likely to be admitted younger (oldest v youngest: RRR, 0.31; 95% CI, 0.15–0.63) and experience repeat admissions (RRR, 1.6; 95% CI, 1.0–2.4).

Conclusions: Young offenders have a much higher death rate than other young Victorians. Early detention, multiple detentions and drug-related offences are indicators of high mortality risk. For these offenders, targeted healthcare while in custody and further mental healthcare and social support after release appear essential if we are to reduce the mortality rate in this group.

Please login with your free MJA account to view this article in full

  • Carolyn Coffey1
  • Andrew W Lovett2
  • Eileen Cini3
  • George C Patton4
  • Rory Wolfe5
  • Paul Moran6

  • 1 Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, VIC.
  • 2 Department of Epidemiology and Preventive Medicine, Monash University and The Alfred Hospital, Melbourne, VIC.
  • 3 Health Services Research Department, Institute of Psychiatry, London, UK.



This study was funded by the National Health and Medical Research Council through the Competing Standard Project Grant 105422; the NHMRC had no role in study design, conduct or interpretation. We would like to thank Professor Ian Anderson for his comments on the article.

Competing interests:

None identified.

  • 1. Coffey C, Veit F, Wolfe R, et al. Mortality in young offenders: retrospective cohort study. BMJ 2003; 326: 1064-1067.
  • 2. O’Shaughnessy RJ. Clinical aspects of forensic assessment of juvenile offenders. Psychiatr Clin North Am 1992; 15: 721-735.
  • 3. Stewart A, Dennison S, Waterson E. Pathways from child maltreatment to juvenile offending. Griffith: School of Criminology and Criminal Justice, Griffith University, 2002.
  • 4. Carr MB, Vandiver TA. Risk and protective factors among youth offenders. Adolescence 2001; 36: 409-426.
  • 5. Beyers JM, Loeber R. Untangling developmental relations between depressed mood and delinquency in male adolescents. J Abnorm Child Psychol 2003; 31: 247-266.
  • 6. Teplin LA, Abram KM, McClelland GM, et al. Psychiatric disorders in youth in juvenile detention. Arch Gen Psychiatry 2002; 59: 1133-1143.
  • 7. Kosky RJ, Sawyer MG, Fotheringham M. The mental health status of adolescents released from custody: a preliminary study. Aust N Z J Psychiatry 1996; 30: 326-331.
  • 8. Fasher AM, Dunbar N, Rothenbury BA, et al. The health of a group of young Australians in a New South Wales juvenile justice centre: a pilot study. J Paediatr Child Health 1997; 33: 426-429.
  • 9. Bareja M, Charlton K. Statistics on juvenile detention in Australia: 1981–2002, Technical and Background Paper Series, no. 5. Canberra: Australian Institute of Criminology; 2003.
  • 10. Beyer L, Reid G, Crofts N. Ethnic based differences in drug offending. Aust N Z J Criminology 2001; 34: 169-181.
  • 11. Anderson I. Understanding Indigenous violence. Aust N Z J Public Health 2002; 26: 408-409.
  • 12. Cavanagh JT, Carson AJ, Sharpe M, et al. Psychological autopsy studies of suicide: a systematic review. Psychol Med 2003; 33: 395-405.
  • 13. WHO. The international classification of diseases, 9th revision, clinical modification. 2nd ed. Washington, DC: US Dept of Health and Human Services; 1980.
  • 14. WHO. International statistical classification of diseases and related health problems, 10th revision. 10th ed. Geneva: World Health Organization; 1992.
  • 15. Australian Bureau of Statistics. 1234.0 Australian standard offence classification. Canberra: ABS, 1997.
  • 16. Stata. Stata statistical software: release 8 [computer program]. College Station, Tx: Stata Corporation, 2003.
  • 17. Shaw J, Baker D, Hunt IM, et al. Suicide by prisoners: national clinical survey. Br J Psychiatry 2004; 184: 263-267.
  • 18. Stattin H, Romelsjo A. Adult mortality in the light of criminality, substance abuse, and behavioural and family-risk factors in adolescence. Crim Behav Ment Health 1995; 5: 279-311.
  • 19. Harris R. Recidivism among Victorian juvenile justice clients 1997–2001. Melbourne: Department of Human Services; 2001.
  • 20. Moffitt TE. Adolescence-limited and life-course-persistent antisocial behavior: a developmental taxonomy. Psychol Rev 1993; 100: 674-701.
  • 21. Luntz BK, Widom CS. Antisocial personality disorder in abused and neglected children grown up. Am J Psychiatry 1994; 151: 670-674.
  • 22. Martin RL, Cloninger CR, Guze SB, et al. Mortality in a follow-up of 500 psychiatric outpatients. II. Cause-specific mortality. Arch Gen Psychiatry 1985; 42: 58-66.
  • 23. Australian Bureau of Statistics. 4119.0 Children, Australia: a social report. Canberra: ABS, 25 Feb 1999.
  • 24. Stewart LM, Henderson CJ, Hobbs MST, et al. Risk of death in prisoners after release from jail. Aust N Z J Public Health 2004; 28: 32-36.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.