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Impact of Interventions for At-Risk and Criminally Involved Youths and Adults on Premature Mortality over the Life-Course: a Systematic Review and Meta-analysis

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Abstract

Premature mortality represents an important outcome for crime and violence prevention and related social interventions, but little is known about premature mortality in relation to these interventions. This article assesses the impact of interventions for at-risk and criminally involved youths and adults on premature mortality over the life-course. Systematic review methods are used, including comprehensive search strategies to identify, screen, and code eligible studies. Meta-analytic techniques are used to assess the impact of interventions on premature mortality, the influence of key moderators, and cause of mortality (natural vs. unnatural). A total of 11 studies met the inclusion criteria. Studies originated in five countries and were reported in the last two decades. Sample size can be considered large (> 500 participants) for all but two of the studies. Analysis of pooled effects showed a non-significant impact of interventions on premature mortality (OR = 0.89; 95% CI: 0.46, 1.74). Life-course stage, intervention type, and evaluation design did not moderate the mean effect. Of the nine studies that reported cause of mortality, interventions were associated with an increased likelihood of death by unnatural causes (OR = 1.78; 95% CI: 1.05, 2.39; p = .03). We conclude that greater attention needs to be paid to evaluating and understanding premature mortality over the life-course as part of the study of the effectiveness of crime and violence prevention interventions, and research opportunities exist to make an immediate contribution to this body of knowledge.

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Notes

  1. As part of our search strategies, identifying non-English language studies is possible whenever studies provide English language abstracts or summaries or key words. Upon identifying a non-English language study, we used Google translation services to translate the full study. The study was then reviewed to determine if it met the inclusion criteria.

  2. In cases of zero counts, the software adds a fixed value (0.5) to each cell for computation of the logged OR and its variance.

  3. It is important to note that, as with all systematic reviews, the initial number of references is highly inflated. There are several main reasons for this, including that only a small proportion are research studies, a substantial number are duplicates, and many more are completely unrelated to the topic (the latter is a result of poor search algorithms in some of the databases). For these reasons, we present this number as an estimate in Fig. 1.

  4. For the purposes of analyses of premature mortality in the CSYS, the full 72-year post-intervention follow-up could not be used. Instead, it was important to use one of the early cut-off age groups, and, for consistency with other long-term studies of premature mortality (e.g., Laub and Vaillant, 2000), we selected < 40 years.

  5. Nine studies reported cohort event data from which we calculated effect sizes, while two studies (Gisev et al., 2015; Welsh et al., 2019) reported ORs, confidence intervals, and p values that were used to calculate effect sizes (see Table 1).

  6. Two studies from the main meta-analysis were excluded because they did not report cause of death. Pritchard and King (2000) focused only on violent deaths, so there is no variation in cause of death (i.e., they are all suicides), and Gisev et al. (2015) did not report cause of premature mortality.

  7. Importantly, the association between interventions and higher likelihood of unnatural death is not necessarily causal in nature.

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Acknowledgements

We are extremely grateful to the three anonymous reviewers and the journal editor for insightful comments.

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Authors and Affiliations

  1. School of Criminology and Criminal Justice, Northeastern University, Boston, MA, USA

    Brandon C. Welsh & Jillian Reeves

  2. Florida State University, Tallahassee, FL, USA

    Steven N. Zane

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Correspondence to Brandon C. Welsh.

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Welsh, B.C., Zane, S.N. & Reeves, J. Impact of Interventions for At-Risk and Criminally Involved Youths and Adults on Premature Mortality over the Life-Course: a Systematic Review and Meta-analysis. J Dev Life Course Criminology 8, 25–46 (2022). https://doi.org/10.1007/s40865-021-00185-5

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