Financial Cost of Insecure Attachment in At-Risk Young People

Abstract

Background: Effective clinical practice and social policy require understanding sources of economic costs of poor mental health in young people. A potent risk-indicator of high lifetime health, social and economic costs is adolescent antisocial behaviour, characterised psychiatrically as Oppositional Defiant Disorder and Conduct Disorder. Over the lifespan, such youth cost society ten times more than their well-adjusted peers, estimated on average at £260,000 extra each and more in severe cases. An insecure attachment pattern is related to sub-optimal care-giving and is common in at-risk youth, who are more distrustful of adults and authority-figures, yet little is known about its economic consequences. Objectives: To determine whether already early in adolescence, cost differences are emerging associated with attachment insecurity in at-risk youth, after accounting for antisocial behaviour, IQ, and socio-economic status. Methods: Sample: 174 young people followed-up aged 9-17 years (mean 12.1, sd 1.8): 85 recruited with moderate antisocial behaviour (80th percentile) from a school screen when younger; 89 clinically referred with very high antisocial behaviour (98th percentile) when younger. Measures: costs by detailed health economic interview; attachment security to mother and father from interview; diagnostic interviews for oppositional and conduct problems; self-reported delinquent behaviour. Findings: Costs were greater for youth insecurely attached to their mothers (secure £6,743 per year, insecure £10,199, p =0.001) and more so to fathers (secure £1,353, insecure £13,978, p <0.001). These differences remained significant (mother p=0.019, father p<0.001) after adjusting for confounders, notably family income and education, intelligence and antisocial behaviour severity. Interpretation: Attachment insecurity is a significant predictor of public cost in at-risk youth, even after accounting for covariates. Adolescent attachment security is influenced by caregiving quality earlier in childhood, therefore these findings add support to the case for early parenting interventions to improve child outcomes and reduce the financial burden on society. Funding Statement: This study was supported by grant 1206/2491 from The Healthcare Foundation. Declaration of Interests: Drs Scott and O’Connor received a grant from The Healthcare Foundation to carry out the work. They have no other interests, and the other authors have no interests to declare Ethics Approval Statement: The study was approved by the research ethics committee of King’s College London (Reference 242/03), and written informed consent was obtained from parents and youths.