Environmental Risk Factors of Conduct Disorder: An Overview of Meta-Analyses
-
Maryam Salmanian
,
Amir-Hassan Bordbari
,
Nazanin Mousavi
,
Shima Tamannaeifar
,
Mohammad Hasan Golzar
,
Melika Amiri
,
Saeed Kargar-Soleimanabad
,
Aghil Mollaei
,
Seyyed Muhammad Mahdi Mahdavinoor
Abstract
Background: Conduct disorder is one of the most common disorders of childhood and adolescence. This disorder imposes high costs for the individual, family and community. Understanding the risk factors associated with conduct disorder can portray a comprehensive picture of it. Therefore, the aim of this study is to investigate the risk factors related with conduct disorder.
Methods: We included meta-analyses that reported one or more risk factors of conduct disorder. We searched PubMed and Scopus until June 25, 2024. Two authors assessed the quality of the included studies independently using the ROBIS. Two authors also extracted relevant data independently.
Results: We found 9 articles that met the inclusion criteria, from which information of 13 meta-analyses was extracted. The risk factors identified by the meta-analyses were as follows: severe psychiatric disorders in parents, postnatal exposure to second-hand smoke, atopic dermatitis , being children of alcoholics, prenatal alcohol exposure, maternal smoking during pregnancy, maternal alcohol use during pregnancy, and overweight/obesity.
Conclusions: Drawing on 13 meta-analyses, this study provides a comprehensive synthesis of the risk factors associated with conduct disorder. The findings can inform policymakers and healthcare professionals for developing targeted interventions, such as public health campaigns and support programs for at-risk families, in order to mitigate these risks. Furthermore, this study highlights the gaps in the existing literature, including the reliance on older studies and methodological limitations, paving the way for future research to address these shortcomings and strengthen the evidence base.
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3. Pisano S, Muratori P, Gorga C, Levantini V, Iuliano R, Catone G, et al. Conduct disorders and psychopathy in children and adolescents: aetiology, clinical presentation and treatment strategies of callous-unemotional traits. Ital J Pediatr. 2017;43(1):84.
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6. Erskine HE, Norman RE, Ferrari AJ, Chan GC, Copeland WE, Whiteford HA, et al. Long-Term Outcomes of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder: A Systematic Review and Meta-Analysis. J Am Acad Child Adolesc Psychiatry. 2016;55(10):841-50.
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12. Salvatore JE, Dick DM. Genetic influences on conduct disorder. Neurosci Biobehav Rev. 2018;91:91-101.
13. Boden JM, Fergusson DM, Horwood LJ. Risk factors for conduct disorder and oppositional/defiant disorder: evidence from a New Zealand birth cohort. J Am Acad Child Adolesc Psychiatry. 2010;49(11):1125-33.
14. Kunitz SJ, Gabriel KR, Levy JE, Henderson E, Lampert K, McCloskey J, et al. Risk factors for conduct disorder among Navajo Indian men and women. Soc Psychiatry Psychiatr Epidemiol. 1999;34(4):180-9.
15. Nujić D, Musić Milanović S, Milas V, Miškulin I, Ivić V, Milas J. Association between child/adolescent overweight/obesity and conduct disorder: A systematic review and meta-analysis. Pediatr Obes. 2021;16(5):e12742.
16. Reid WJ, Crisafulli A. Marital discord and child behavior problems: a meta-analysis. J Abnorm Child Psychol. 1990;18(1):105-17.
17. Ruisch IH, Dietrich A, Glennon JC, Buitelaar JK, Hoekstra PJ. Maternal substance use during pregnancy and offspring conduct problems: A meta-analysis. Neurosci Biobehav Rev. 2018;84:325-36.
18. Wetherill L, Foroud T, Goodlett C. Meta-Analyses of Externalizing Disorders: Genetics or Prenatal Alcohol Exposure? Alcohol Clin Exp Res. 2018;42(1):162-72.
19. Xie QW, Dai X, Tang X, Chan CHY, Chan CLW. Risk of Mental Disorders in Children and Adolescents With Atopic Dermatitis: A Systematic Review and Meta-Analysis. Front Psychol. 2019;10:1773.
20. Maniglio R. Prevalence of sexual abuse among children with conduct disorder: a systematic review. Clin Child Fam Psychol Rev. 2014;17(3):268-82.
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24. Ayano G, Betts K, Maravilla JC, Alati R. A Systematic Review and Meta-Analysis of the Risk of Disruptive Behavioral Disorders in the Offspring of Parents with Severe Psychiatric Disorders. Child Psychiatry Hum Dev. 2021;52(1):77-95.
25. Fellmeth G, Rose-Clarke K, Zhao C, Busert LK, Zheng Y, Massazza A, et al. Health impacts of parental migration on left-behind children and adolescents: a systematic review and meta-analysis. Lancet. 2018;392(10164):2567-82.
26. Huang A, Wu K, Cai Z, Lin Y, Zhang X, Huang Y. Association between postnatal second-hand smoke exposure and ADHD in children: a systematic review and meta-analysis. Environ Sci Pollut Res Int. 2021;28(2):1370-80.
27. Duko B, Mengistu TS, Stacey D, Moran LJ, Tessema G, Pereira G, et al. Associations between maternal preconception and pregnancy adiposity and neuropsychiatric and behavioral outcomes in the offspring: A systematic review and meta-analysis. Psychiatry Res. 2024;342:116149.
28. Lin K, Mak L, Cai J, Jiang S, Fayyaz N, Broadley S, et al. Urbanisation and mental health in left-behind children: systematic review and meta-analysis using resilience framework. Pediatr Res. 2025.
29. Tusa BS, Alati R, Ayano G, Betts K, Weldesenbet AB, Dachew B. Maternal perinatal depression and the risk of disruptive behavioural disorder symptoms among offspring: A systematic review and meta-analysis. Psychiatry Res. 2025;348:116428.
30. Reid WJ, Crisafulli A. Marital discord and child behavior problems: a meta-analysis. J Abnorm Child Psychol. 1990;18(1):105-17.
31. Fullana MA, Tortella-Feliu M, Fernández de la Cruz L, Chamorro J, Pérez-Vigil A, Ioannidis JPA, et al. Risk and protective factors for anxiety and obsessive-compulsive disorders: an umbrella review of systematic reviews and meta-analyses. Psychol Med. 2020;50(8):1300-15.
32. Wu Q, Feng J, Pan CW. Risk factors for depression in the elderly: An umbrella review of published meta-analyses and systematic reviews. J Affect Disord. 2022;307:37-45.
33. Hutchens BF, Kearney J. Risk Factors for Postpartum Depression: An Umbrella Review. J Midwifery Womens Health. 2020;65(1):96-108.
34. Tortella-Feliu M, Fullana MA, Pérez-Vigil A, Torres X, Chamorro J, Littarelli SA, et al. Risk factors for posttraumatic stress disorder: An umbrella review of systematic reviews and meta-analyses. Neurosci Biobehav Rev. 2019;107:154-65.
35. Radua J, Ramella-Cravaro V, Ioannidis JPA, Reichenberg A, Phiphopthatsanee N, Amir T, et al. What causes psychosis? An umbrella review of risk and protective factors. World Psychiatry. 2018;17(1):49-66.
36. Gordis L. Epidemiology e-book: Elsevier Health Sciences; 2013.
37. Gordis L. Epidemiology e-book: Elsevier Health Sciences; 2013. [Available from: https://books.google.com/books?hl=en&lr=&id=7YX6AQAAQBAJ&oi=fnd&pg=PP1&dq=Gordis+L.+Epidemiology.+5th+ed.+Philadelphia:+Saunders+Elsevier%3B+2014&ots=WUsXO7lN9E&sig=2tWIsqvpl5tT7w-9_ZearpCP0_k#v=onepage&q&f=false ]
38. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
2. Fairchild G, Hawes DJ, Frick PJ, Copeland WE, Odgers CL, Franke B, et al. Conduct disorder. Nat Rev Dis Primers. 2019;5(1):43.
3. Pisano S, Muratori P, Gorga C, Levantini V, Iuliano R, Catone G, et al. Conduct disorders and psychopathy in children and adolescents: aetiology, clinical presentation and treatment strategies of callous-unemotional traits. Ital J Pediatr. 2017;43(1):84.
4. Diagnostic A. Statistical manual of mental disorders: DSM-5 (ed.) Washington. DC: American Psychiatric Association. 2013.
5. Akpan MU, Hogan EJ, Okpokowuruk FS, Ikpeme EE. Conduct Disorder among Primary Schoolchildren in Southern Nigeria. Niger Med J. 2020;61(6):334-9.
6. Erskine HE, Norman RE, Ferrari AJ, Chan GC, Copeland WE, Whiteford HA, et al. Long-Term Outcomes of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder: A Systematic Review and Meta-Analysis. J Am Acad Child Adolesc Psychiatry. 2016;55(10):841-50.
7. Masroor A, Patel RS, Bhimanadham NN, Raveendran S, Ahmad N, Queeneth U, et al. Conduct Disorder-Related Hospitalization and Substance Use Disorders in American Teens. Behav Sci (Basel). 2019;9(7):73.
8. Barry CT, Golmaryami FN, Rivera-Hudson N, Frick PJ. Evidence-based assessment of conduct disorder: Current considerations and preparation for DSM-5. Professional Psychology: Research and Practice. 2013;44(1):56.
9. Salmanian M, Asadian-Koohestani F, Mohammadi MR. A systematic review on the prevalence of conduct disorder in the Middle East. Soc Psychiatry Psychiatr Epidemiol. 2017;52(11):1337-43.
10. Mohammadi MR, Salmanian M, Keshavarzi Z. The Global Prevalence of Conduct Disorder: A Systematic Review and Meta-Analysis. Iran J Psychiatry. 2021;16(2):205-25.
11. Wesseldijk LW, Bartels M, Vink JM, van Beijsterveldt CEM, Ligthart L, Boomsma DI, et al. Genetic and environmental influences on conduct and antisocial personality problems in childhood, adolescence, and adulthood. Eur Child Adolesc Psychiatry. 2018;27(9):1123-32.
12. Salvatore JE, Dick DM. Genetic influences on conduct disorder. Neurosci Biobehav Rev. 2018;91:91-101.
13. Boden JM, Fergusson DM, Horwood LJ. Risk factors for conduct disorder and oppositional/defiant disorder: evidence from a New Zealand birth cohort. J Am Acad Child Adolesc Psychiatry. 2010;49(11):1125-33.
14. Kunitz SJ, Gabriel KR, Levy JE, Henderson E, Lampert K, McCloskey J, et al. Risk factors for conduct disorder among Navajo Indian men and women. Soc Psychiatry Psychiatr Epidemiol. 1999;34(4):180-9.
15. Nujić D, Musić Milanović S, Milas V, Miškulin I, Ivić V, Milas J. Association between child/adolescent overweight/obesity and conduct disorder: A systematic review and meta-analysis. Pediatr Obes. 2021;16(5):e12742.
16. Reid WJ, Crisafulli A. Marital discord and child behavior problems: a meta-analysis. J Abnorm Child Psychol. 1990;18(1):105-17.
17. Ruisch IH, Dietrich A, Glennon JC, Buitelaar JK, Hoekstra PJ. Maternal substance use during pregnancy and offspring conduct problems: A meta-analysis. Neurosci Biobehav Rev. 2018;84:325-36.
18. Wetherill L, Foroud T, Goodlett C. Meta-Analyses of Externalizing Disorders: Genetics or Prenatal Alcohol Exposure? Alcohol Clin Exp Res. 2018;42(1):162-72.
19. Xie QW, Dai X, Tang X, Chan CHY, Chan CLW. Risk of Mental Disorders in Children and Adolescents With Atopic Dermatitis: A Systematic Review and Meta-Analysis. Front Psychol. 2019;10:1773.
20. Maniglio R. Prevalence of sexual abuse among children with conduct disorder: a systematic review. Clin Child Fam Psychol Rev. 2014;17(3):268-82.
21. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj. 2021;372:n71.
22. Whiting P, Savović J, Higgins JP, Caldwell DM, Reeves BC, Shea B, et al. ROBIS: A new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol. 2016;69:225-34.
23. Anderson AS, Siciliano RE, Pillai A, Jiang W, Compas BE. Parental drug use disorders and youth psychopathology: Meta-analytic review. Drug Alcohol Depend. 2023;244:109793.
24. Ayano G, Betts K, Maravilla JC, Alati R. A Systematic Review and Meta-Analysis of the Risk of Disruptive Behavioral Disorders in the Offspring of Parents with Severe Psychiatric Disorders. Child Psychiatry Hum Dev. 2021;52(1):77-95.
25. Fellmeth G, Rose-Clarke K, Zhao C, Busert LK, Zheng Y, Massazza A, et al. Health impacts of parental migration on left-behind children and adolescents: a systematic review and meta-analysis. Lancet. 2018;392(10164):2567-82.
26. Huang A, Wu K, Cai Z, Lin Y, Zhang X, Huang Y. Association between postnatal second-hand smoke exposure and ADHD in children: a systematic review and meta-analysis. Environ Sci Pollut Res Int. 2021;28(2):1370-80.
27. Duko B, Mengistu TS, Stacey D, Moran LJ, Tessema G, Pereira G, et al. Associations between maternal preconception and pregnancy adiposity and neuropsychiatric and behavioral outcomes in the offspring: A systematic review and meta-analysis. Psychiatry Res. 2024;342:116149.
28. Lin K, Mak L, Cai J, Jiang S, Fayyaz N, Broadley S, et al. Urbanisation and mental health in left-behind children: systematic review and meta-analysis using resilience framework. Pediatr Res. 2025.
29. Tusa BS, Alati R, Ayano G, Betts K, Weldesenbet AB, Dachew B. Maternal perinatal depression and the risk of disruptive behavioural disorder symptoms among offspring: A systematic review and meta-analysis. Psychiatry Res. 2025;348:116428.
30. Reid WJ, Crisafulli A. Marital discord and child behavior problems: a meta-analysis. J Abnorm Child Psychol. 1990;18(1):105-17.
31. Fullana MA, Tortella-Feliu M, Fernández de la Cruz L, Chamorro J, Pérez-Vigil A, Ioannidis JPA, et al. Risk and protective factors for anxiety and obsessive-compulsive disorders: an umbrella review of systematic reviews and meta-analyses. Psychol Med. 2020;50(8):1300-15.
32. Wu Q, Feng J, Pan CW. Risk factors for depression in the elderly: An umbrella review of published meta-analyses and systematic reviews. J Affect Disord. 2022;307:37-45.
33. Hutchens BF, Kearney J. Risk Factors for Postpartum Depression: An Umbrella Review. J Midwifery Womens Health. 2020;65(1):96-108.
34. Tortella-Feliu M, Fullana MA, Pérez-Vigil A, Torres X, Chamorro J, Littarelli SA, et al. Risk factors for posttraumatic stress disorder: An umbrella review of systematic reviews and meta-analyses. Neurosci Biobehav Rev. 2019;107:154-65.
35. Radua J, Ramella-Cravaro V, Ioannidis JPA, Reichenberg A, Phiphopthatsanee N, Amir T, et al. What causes psychosis? An umbrella review of risk and protective factors. World Psychiatry. 2018;17(1):49-66.
36. Gordis L. Epidemiology e-book: Elsevier Health Sciences; 2013.
37. Gordis L. Epidemiology e-book: Elsevier Health Sciences; 2013. [Available from: https://books.google.com/books?hl=en&lr=&id=7YX6AQAAQBAJ&oi=fnd&pg=PP1&dq=Gordis+L.+Epidemiology.+5th+ed.+Philadelphia:+Saunders+Elsevier%3B+2014&ots=WUsXO7lN9E&sig=2tWIsqvpl5tT7w-9_ZearpCP0_k#v=onepage&q&f=false ]
38. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
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How to Cite
1.
Salmanian M, Bordbari A-H, Mousavi N, Tamannaeifar S, Golzar MH, Amiri M, Kargar-Soleimanabad S, Mollaei A, Mahdavinoor SMM. Environmental Risk Factors of Conduct Disorder: An Overview of Meta-Analyses. Iran J Psychiatry. 2025;:1-9.
