Prevalence and persistence of psychiatric disorders in youth after detention: a prospective longitudinal study

Mental Illness Drives Hospitalizations for Detained California Youth

PURPOSE

The purpose of the study was to describe inpatient hospitalization patterns among detained and nondetained youth in a large, total population of hospitalized adolescents in California.

METHODS

We examined the unmasked California Office of Statewide Health Planning and Development Patient Discharge Dataset from 1997 to 2011. We considered hospitalized youth aged 11-18 years "detained" if admitted to California hospitals from detention, transferred from hospital to detention, or both. We compared discharge diagnoses and length of stay between detained youth and their nondetained counterparts in the general population.

RESULTS

There were 11,367 hospitalizations for detained youth. Hospitalizations differed for detained versus nondetained youth: 63% of all detained youth had a primary diagnosis of mental health disorder (compared with 19.8% of nondetained youth). Detained girls were disproportionately affected, with 74% hospitalized for a primary mental health diagnosis. Detained youth hospitalized for mental health disorder had an increased median length of stay compared with nondetained inpatient youth with mental illness (≥ 6 days vs. 5 days, respectively). This group difference was heightened in the presence of minority status, public insurance, and concurrent substance abuse. Hospitalized detained youth discharged to chemical dependency treatment facilities had the longest hospital stays (≥ 43 days).

CONCLUSIONS

Detained juvenile offenders are hospitalized for very different reasons than the general adolescent population. Mental illness, often with comorbid substance abuse, requiring long inpatient stays, represents the major cause for hospitalization. These findings underscore the urgent need for effective, well-coordinated mental health services for youth before, during, and after detention.

Risks, Outcomes, and Evidence-Based Interventions for Girls in the US Juvenile Justice System

The proportion of the juvenile justice population that comprises females is increasing, yet few evidence-based models have been evaluated and implemented with girls in the juvenile justice system. Although much is known about the risk and protective factors for girls who participate in serious delinquency, significant gaps in the research base hamper the development and implementation of theoretically based intervention approaches. In this review, we first summarize the extant empirical work about the predictors and sequelae of juvenile justice involvement for girls. Identified risk and protective factors that correspond to girls' involvement in the juvenile justice system have been shown to largely parallel those of boys, although exposure rates and magnitudes of association sometimes differ by sex. Second, we summarize findings from empirically validated, evidence-based interventions for juvenile justice-involved youths that have been tested with girls. The interventions include Functional Family Therapy, Multisystemic Therapy, Multidimensional Family Therapy, and Treatment Foster Care Oregon (formerly known as Multidimensional Treatment Foster Care). We conclude that existing evidence-based practices appear to be effective for girls. However, few studies have been sufficiently designed to permit conclusions about whether sex-specific interventions would yield any better outcomes for girls than would interventions that already exist for both sexes and that have a strong base of evidence to support them. Third, we propose recommendations for feasible, cost-efficient next steps to advance the research and intervention agendas for this under-researched and underserved population of highly vulnerable youths.

Associations between psychotic symptoms and substance use in young offenders

INTRODUCTION AND AIMS

Substance use and psychotic symptoms/disorders are associated. There has been little examination of this issue in young offenders, despite elevated substance use in this group.

DESIGN AND METHODS

Semistructured interviews were conducted by trained researchers with 514 young offenders. Psychotic symptoms were assessed using a previously validated screening measure, with scores ≥3 indicative of possible psychotic disorder. Associations between this indicator and patterns of offending, common symptoms of mental disorders and health risk behaviours, including substance use were examined. The extent to which substance use and psychotic symptoms remained associated after adjustment for possible confounding was evaluated.

RESULTS

Thirteen percent screened positive for psychosis. Participants who screened positive for psychosis were more likely than those who did not to have: unstable housing; been expelled from school; a family history of substance use/mental health problems, and depressive symptoms. Amphetamine, sedative and cannabis dependence were all strongly associated with screening positive for psychosis. Screening positive remained significantly associated with amphetamine and sedative dependence, and daily cannabis and sedative use, in multivariable regressions.

DISCUSSION AND CONCLUSIONS

One in eight young offenders reported symptoms consistent with psychosis. Symptomatology was strongly associated with heavy use of a range of illicit drugs. Given the frequency of these symptoms and the potential for them to be related to or exacerbated by drug use, this study highlights the importance of co-ordinated alcohol and other drugs and mental health treatment for young offenders, both due to co-occurrence and given the possibility that treating SUDs may impact on mental health symptoms.

Prevalence and correlates of psychiatric disorders among former juvenile detainees in the United States

OBJECTIVE

Juvenile offenders face increased liability for psychiatric disorders and greater psychopathology, but little is known about the psychiatric status of former juvenile delinquents as adults.

METHOD

Drawing on data from Wave 1 and Wave 2 of the NESARC, logistic regression models examine correlates of psychiatric disorders in a large nationally representative sample of former juvenile detainees in adulthood (n=1177) compared to adults who did not have a history of juvenile offending (n=33,193). Further, we explored the psychosocial correlates associated with the increased likelihood of psychiatric disorders among former juvenile detainees.

RESULTS

Nearly half of former juvenile detainees met criteria for one or more psychiatric disorders in the past twelve months and approximately two-thirds meet criteria for any lifetime personality disorder. Compared to the general population, former juvenile detainees not only denote greater psychiatric comorbidity across a range of affective, personality, and substance use disorders but are also more likely to report childhood adversity.

CONCLUSIONS

Former juvenile detainees experience significantly greater and more varied psychiatric problems across adulthood.

HIV Knowledge Among a Longitudinal Cohort of Juvenile Detainees in an Urban Setting

The authors investigated HIV knowledge change among a cohort of juvenile detainees. Participants completed an HIV knowledge survey at baseline and up to 4 more times over 6 years. The authors calculated knowledge scores; the time serial trend of scores was modeled using generalized estimating equations. A baseline survey was completed by 798 participants, ages 14 to 18 years; mean HIV knowledge scores ranged from 11.4 to 14.1 (maximum score = 18). Males had significantly lower HIV knowledge scores than females at baseline only. Over time, Hispanic participants had significantly lower scores than non-Hispanic Black and non-Hispanic White participants. Overall, HIV knowledge increased but was still suboptimal 5 years after baseline. These findings suggest the need to develop and strengthen HIV prevention education programs in youth detention settings.

Psychiatric disorders and violence: a study of delinquent youth after detention

OBJECTIVE

To examine the relationship between psychiatric disorders and violence in delinquent youth after detention.

METHOD

The Northwestern Juvenile Project is a longitudinal study of youth from the Cook County Juvenile Temporary Detention Center (Chicago, Illinois). Violence and psychiatric disorders were assessed via self-report in 1,659 youth (56% African American, 28% Hispanic, 36% female, aged 13-25 years) interviewed up to 4 times between 3 and 5 years after detention. Using generalized estimating equations and logistic regression, we examined the following: the prevalence of violence 3 and 5 years after detention; the contemporaneous relationships between psychiatric disorders and violence as youth age; and whether the presence of a psychiatric disorder predicts subsequent violence.

RESULTS

Rates of any violence decreased between 3 and 5 years after detention, from 35% to 21% (males), and from 20% to 17% (females). There was a contemporaneous relationship between disorder and violence. Compared to the group with no disorder, males and females with any disorder had greater odds of any violence (adjusted odds ratio [AOR] = 3.0, 95% CI = 1.9-4.7, and AOR = 4.4, 95% CI = 3.0-6.3, respectively). All specific disorders were associated contemporaneously with violence, except for major depressive disorder/dysthymia among males. Substance use disorders predicted subsequent violence. Males with other drug use disorder and females with marijuana use disorder 3 years after detention had greater odds of any violence 2 years later (AOR = 3.4, 95% CI = 1.4-8.2, and AOR = 2.0, 95% CI = 1.1-3.8, respectively).

CONCLUSION

Aside from substance use disorders, the psychiatric disorders studied may not be useful markers of subsequent violence. Violence assessment and reduction must be key components of ongoing psychiatric services for high-risk youth.

A randomized clinical trial of family therapy in juvenile drug court

The objective of this article is to examine the effectiveness of 2 theoretically different treatments delivered in juvenile drug court--family therapy represented by multidimensional family therapy (MDFT) and group-based treatment represented by adolescent group therapy (AGT)--on offending and substance use. Intent-to-treat sample included 112 youth enrolled in juvenile drug court (primarily male [88%], and Hispanic [59%] or African American [35%]), average age 16.1 years, randomly assigned to either family therapy (n = 55) or group therapy (n = 57). Participants were assessed at baseline and 6, 12, 18 and 24 months following baseline. During the drug court phase, youth in both treatments showed significant reduction in delinquency (average d = .51), externalizing symptoms (average d = 2.32), rearrests (average d = 1.22), and substance use (average d = 4.42). During the 24-month follow-up, family therapy evidenced greater maintenance of treatment gains than group-based treatment for externalizing symptoms (d = 0.39), commission of serious crimes (d = .38), and felony arrests (d = .96). There was no significant difference between the treatments with respect to substance use or misdemeanor arrests. The results suggest that family therapy enhances juvenile drug court outcomes beyond what can be achieved with a nonfamily based treatment, especially with respect to what is arguably the primary objective of juvenile drug courts: reducing criminal behavior and rearrests. More research is needed on the effectiveness of juvenile drug courts generally and on whether treatment type and family involvement influence outcomes.

TRIAL REGISTRY NAME

Clinical Trials.gov, Identified NCT01668303.

Working with complex problem behaviors in juvenile institutional care: staff's competence, organizational conditions and public value

PURPOSE

Institutional staff encounter juveniles with complex problems (externalizing and internalizing) which calls for adequate formal education/training and professional experience to deliver quality treatment, contributing to an effective organization and increasing public value. The purpose of this paper is to investigate staff's formal education, professional experience and the institutions' organizational strategies providing knowledge and clinical training to staff.

DESIGN/METHODOLOGY/APPROACH

The study includes staff questionnaires from eight wards (n=102). In addition, 39 in-depth interviews were conducted with management and staff members.

FINDINGS

Results show that institutions lack clearly defined target groups, 70 percent of staff members lack college education, 30 percent has never been offered education within the organization, and the vast majority of staff does not feel competent in performing their daily work. Practical implications - The results from this study shed light on an overlooked area in institutions, detention centers and prison settings, and are important to policy makers and governmental organizations responsible for coercive care of juveniles.

ORIGINALITY/VALUE

Unlike previous studies, treatment and detention organizations are emphasized as similar to manufacturing industry and profit organizations, and the results are discussed with departure in organizational theory.

Personality dysfunction is the cause of recurrent non-cognitive mental disorder: a testable hypothesis

OBJECTIVE

The objective of this study is to examine the evidence for a new hypothesis explaining the relationship between personality and mental state disorders.

DESIGN

At present, the attribution of personality disorder as a primary diagnosis only applies to patients who are antisocial, and particularly regarded as psychopathic, as in these patients, the mental state disorder that are associated are regarded in many respects as atypical and not representative of other mental disorders. The case is made in this paper that personality dysfunction lies behind the persistence of all non-cognitive mental disorders and that our failure to recognise this follows from our collective refusal to assess personality status early in life.

METHOD

Narrative review of relevant literature, which is limited as personality status is not often assessed early in life.

RESULTS

Support is adduced that personality dysfunction lies behind the persistence of all non-cognitive mental disorders (i.e. those that are not specifically neurodevelopmental and linked to cognitive impairment). The potential importance of this hypothesis is presented with regard to treatment and management strategy, emphasising that without specific intervention for personality dysfunction, many patients are destined for persistent morbidity.

Comorbidity and continuity of psychiatric disorders in youth after detention: a prospective longitudinal study

IMPORTANCE

Psychiatric disorders and comorbidity are prevalent among incarcerated juveniles. To date, no large-scale study has examined the comorbidity and continuity of psychiatric disorders after youth leave detention.

OBJECTIVE

To determine the comorbidity and continuity of psychiatric disorders among youth 5 years after detention.

DESIGN, SETTING, AND PARTICIPANTS

Prospective longitudinal study of a stratified random sample of 1829 youth (1172 male and 657 female; 1005 African American, 296 non-Hispanic white, 524 Hispanic, and 4 other race/ethnicity) recruited from the Cook County Juvenile Temporary Detention Center, Chicago, Illinois, between November 20, 1995, and June 14, 1998, and who received their time 2 follow-up interview between May 22, 2000, and April 3, 2004.

MAIN OUTCOMES AND MEASURES

At baseline, the Diagnostic Interview Schedule for Children Version 2.3. At follow-ups, the Diagnostic Interview Schedule for Children Version IV (child and young adult versions) and the Diagnostic Interview Schedule Version IV (substance use disorders and antisocial personality disorder).

RESULTS

Five years after detention, when participants were 14 to 24 years old, almost 27% of males and 14% of females had comorbid psychiatric disorders. Although females had significantly higher rates of comorbidity when in detention (odds ratio, 1.3; 95% CI, 1.0-1.7), males had significantly higher rates than females at follow-up (odds ratio, 2.3; 95% CI, 1.6-3.3). Substance use plus behavioral disorders was the most common comorbid profile among males, affecting 1 in 6. Participants with more disorders at baseline were more likely to have a disorder approximately 5 years after detention, even after adjusting for demographic characteristics. We found substantial continuity of disorder. However, some baseline disorders predicted alcohol and drug use disorders at follow-up.

CONCLUSIONS AND RELEVANCE

Although prevalence rates of comorbidity decreased in youth after detention, rates remained substantial and were higher than rates in the most comparable studies of the general population. Youth with multiple disorders at baseline are at highest risk for disorder 5 years later. Because many psychiatric disorders first appear in childhood and adolescence, primary and secondary prevention of psychiatric disorders offers the greatest opportunity to reduce costs to individuals, families, and society. Only a concerted effort to address the many needs of delinquent youth will help them thrive in adulthood.

Evaluating the effectiveness of a special needs diversionary program in reducing reoffending among mentally ill youthful offenders

The goal of this study was to evaluate the effectiveness of a mental health intervention for youthful offenders, specifically the Special Needs Diversionary Program (SNDP) by comparing the treatment group with the control group. The sample consisted of 328 mentally ill youths: 168 youths participated in the SNDP and 160 youths in other court-ordered programs. To examine the empirical relationships among the covariates, the current study uses a two-step approach: (a) logistic regression; and (b) Cox Proportional-Hazards Regression. The findings reveal that participation in the SNDP was strongly associated with reduced recidivism compared with nonparticipation in the SNDP among mentally ill youthful offenders throughout the 12-month follow-up. Study limitations and implications for future research are discussed.

Gender differences in recidivism rates for juvenile justice youth: the impact of sexual abuse

Young female offenders represent a growing number of young offenders. Studies have shown that youth in the juvenile justice system, particularly young females, report higher rates of lifetime sexual abuse than their nonoffending peers. The aim of this study was to examine gender differences in risk factors for recidivism, including a history of sexual abuse, among a juvenile court clinic sample. Findings suggest that, even after accounting for previously identified risk factors for recidivism such as prior legal involvement and conduct problems, a history of sexual abuse is the most salient predictor of recidivism for young female offenders, but not for males. The development of gender-responsive interventions to reduce juvenile recidivism and continued legal involvement into adulthood may be warranted.

Firearm homicide and other causes of death in delinquents: a 16-year prospective study

BACKGROUND

Delinquent youth are at risk for early violent death after release from detention. However, few studies have examined risk factors for mortality. Previous investigations studied only serious offenders (a fraction of the juvenile justice population) and provided little data on females.

METHODS

The Northwestern Juvenile Project is a prospective longitudinal study of health needs and outcomes of a stratified random sample of 1829 youth (657 females, 1172 males; 524 Hispanic, 1005 African American, 296 non-Hispanic white, 4 other race/ethnicity) detained between 1995 and 1998. Data on risk factors were drawn from interviews; death records were obtained up to 16 years after detention. We compared all-cause mortality rates and causes of death with those of the general population. Survival analyses were used to examine risk factors for mortality after youth leave detention.

RESULTS

Delinquent youth have higher mortality rates than the general population to age 29 years (P < .05), irrespective of gender or race/ethnicity. Females died at nearly 5 times the general population rate (P < .05); Hispanic males and females died at 5 and 9 times the general population rates, respectively (P < .05). Compared with the general population, significantly more delinquent youth died of homicide and its subcategory, homicide by firearm (P < .05). Among delinquent youth, racial/ethnic minorities were at increased risk of homicide compared with non-Hispanic whites (P < .05). Significant risk factors for external-cause mortality and homicide included drug dealing (up to 9 years later), alcohol use disorder, and gang membership (up to a decade later).

CONCLUSIONS

Delinquent youth are an identifiable target population to reduce disparities in early violent death.

Complex health needs in the youth justice system: a survey of community-based and custodial offenders

PURPOSE

Estimate the prevalence and annual frequency of health risk indicators in young people serving community-based orders (CBOs) and custodial orders in the state of Victoria, Australia.

METHODS

Cross-sectional survey of 242 young people serving CBOs and 273 serving custodial orders in Victoria in 2002-2003. Validated measures included the Composite International Diagnostic Interview for substance dependence, Short Mood and Feelings Questionnaire for depression, and Psychosis Screening Questionnaire for psychosis symptoms. Prevalence estimates were adjusted for sampling bias and age- and sex-adjusted for between-group comparisons. Prevalence estimates were applied to 2010-2011 Victorian youth justice data to estimate annual frequencies at the state level.

RESULTS

The prevalence of substance dependence, poor mental health, and risky sexual behavior was high in both groups. Age- and sex-adjusted prevalence estimates were generally higher among those serving custodial orders; however, extrapolating prevalence estimates to statewide youth justice data generally resulted in higher estimated annual frequencies among CBOs. For example, the estimated prevalence of any substance dependence was 66% (95% confidence interval [CI], 60-72) in those serving custodial orders and 34% (95% CI, 26-42) in CBOs, but the estimated frequency of substance dependence in CBOs in 2010-2011 was 970 (95% CI, 750-1,180), compared with 490 (95% CI, 450-530) in those serving a custodial order.

CONCLUSIONS

There is a compelling case for scaling up health services for young offenders in custody and in the community, and for routinely monitoring the health of young offenders serving custodial and community orders.

Drug Use Trajectories After a Randomized Controlled Trial of MTFC: Associations with Partner Drug Use

Trajectories of drug use were examined in a sample of women with prior juvenile-justice system involvement. One hundred fifty-three young women who participated in a randomized controlled trial of Multidimensional Treatment Foster Care (MTFC) in adolescence were assessed on five occasions over a 24-month period in young adulthood (mean age = 22.29 years at T1). Participants assigned to the MTFC condition during adolescence reported greater decreases in drug use than girls assigned to the treatment as usual (TAU) condition. Partner drug use was significantly associated with women's concurrent drug use, although participants in the MTFC condition were more resilient to partner drug use than in the TAU condition. Implications for drug use prevention and intervention programs during adolescence are discussed.