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Edited by Timothy D. Wilson, University of Virginia, Charlottesville, VA, and approved October 26, 2020 (received for review August 1, 2020)
Significance
Mortality among young adults (age 25 to 44) is rising due in part to preventable, self-inflicted deaths from suicide, alcohol-related liver disease, and drug overdose. This study finds that a comprehensive childhood intervention (Fast Track) designed to reduce conduct problems in at-risk children also reduces the probability of exhibiting adolescent and young adulthood behaviors that precede these deaths, including suicidal ideation and hazardous drinking as well as opioid use in young adulthood. Intervention-driven improvements in children’s interpersonal, intrapersonal, and academic skills in elementary and middle school partially mediate the direct intervention effect on adolescent and young adult behaviors of despair with a strong indirect pathway through earlier acquisition of interpersonal skills.
Abstract
How to mitigate the dramatic increase in the number of self-inflicted deaths from suicide, alcohol-related liver disease, and drug overdose among young adults has become a critical public health question. A promising area of study looks at interventions designed to address risk factors for the behaviors that precede these —often denoted—“deaths of despair.” This paper examines whether a childhood intervention can have persistent positive effects by reducing adolescent and young adulthood (age 25) behaviors that precede these deaths, including suicidal ideation, suicide attempts, hazardous drinking, and opioid use. These analyses test the impact and mechanisms of action of Fast Track (FT), a comprehensive childhood intervention designed to decrease aggression and delinquency in at-risk kindergarteners. We find that random assignment to FT significantly decreases the probability of exhibiting any behavior of despair in adolescence and young adulthood. In addition, the intervention decreases the probability of suicidal ideation and hazardous drinking in adolescence and young adulthood as well as opioid use in young adulthood. Additional analyses indicate that FT’s improvements to children’s interpersonal (e.g., prosocial behavior, authority acceptance), intrapersonal (e.g., emotional recognition and regulation, social problem solving), and academic skills in elementary and middle school partially mediate the intervention effect on adolescent and young adult behaviors of despair and self-destruction. FT’s improvements to interpersonal skills emerge as the strongest indirect pathway to reduce these harmful behaviors. This study provides evidence that childhood interventions designed to improve these skills can decrease the behaviors associated with premature mortality.
Footnotes
- ↵1To whom correspondence may be addressed. Email: jgodwin{at}duke.edu.
↵2A complete list of the Conduct Problems Prevention Research Group can be found in the Acknowledgments.
Author contributions: CPPRG designed research; CPPRG performed research; J.W.G. analyzed data; J.W.G. wrote the paper; and CPPRG discussed and reviewed the results.
The authors declare no competing interest.
This article is a PNAS Direct Submission.
This article contains supporting information online at https://www.pnas.org/lookup/suppl/doi:10.1073/pnas.2016234117/-/DCSupplemental.
Data Availability.
Researchers with IRB-approval can request the Fast Track data and code used in these analyses by submitting a short application (https://fasttrackproject.org/request-use-data.php).
Published under the PNAS license.
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The Fast Track intervention’s impact on behaviors of despair in adolescence and young adulthood
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