Posttraumatic stress disorder in incarcerated juvenile delinquents

The child and family traumatic stress intervention: Factors associated with symptom reduction for children receiving treatment

OBJECTIVE

We examine factors associated with changes in posttraumatic stress symptoms for children following completion of an early and brief, trauma-focused mental health treatment that engages children together with their caregivers, with the child as the identified patient.

METHOD

The Child and Family Traumatic Stress Intervention (CFTSI), a brief (5-8 session) trauma-focused mental health treatment designed to reduce trauma symptoms in the aftermath of traumatic experiences in children aged 7 years and older. CFTSI has been widely disseminated in Child Advocacy Centers (CAC) and community treatment clinics nationally. We report on results of a naturalistic treatment study of CFTSI implementation without a comparison group that includes 1190 child caregiver dyads from 13 community-based clinical settings.

RESULTS

Mixed modeling revealed a significant reduction in child reported posttraumatic stress scores from pre to post-CFTSI. Scores on the Child Posttraumatic Checklist (CPSS) declined an average of 8.74 points from pre to post-CFTSI (p < .0001). There were no statistically significant differences in CPSS score changes based on age, gender, ethnicity, race, number of prior trauma types the child had experienced, caregiver posttraumatic stress symptoms, child relationship to the perpetrator, nature of event or length of time to begin treatment.

CONCLUSION

This study provides further evidence that CFTSI can reduce child posttraumatic stress symptoms when implemented by community-based providers.

Symptoms of Posttraumatic Stress and Sexual Concerns: The Intermediary Effects of Executive Functioning on Profiles of Youth Who Have Sexually Harmed

There are demonstrated links in the general population between developmental adversity, associated trauma symptoms, and executive functioning difficulties in children and youth. However, research on links among these indicators and their relationship to antisocial behavior more broadly in samples of youth who have sexually harmed is only beginning to emerge. Some research indicates that intermediary factors like sexual concerns may be critical in understanding this population. This study explored relationships between trauma symptoms, sexual concerns, executive functioning, and their relationship to non-sexual delinquency in a sample of 196 youth who committed sexual harm. Structural equation modeling revealed numerous direct and indirect effects on the path to delinquency and that executive functioning plays a key role among those with serious sexual concerns. The results are contextualized and implications are discussed.

Does a unique co-occurring OCD and PTSD factor structure exist?: Examination of overlapping OCD and PTSD symptom clusters

OCD and PTSD share many commonalities, including phenotypic and functional overlap in symptoms. Specifically, both disorders are characterized by unwanted, intrusive, anxiety/distress-eliciting intrusive thoughts and evoking behaviors intended to control, neutralize, suppress, or outright avoid intrusive thoughts and associated anxiety/distress. Extant factor analytic research supports a model of PTSD at odds with current DSM-5 criteria, and no examination of the factor structure of comorbid OCD+PTSD currently exists despite the noted overlap in symptomatology and high rates of comorbidity. Using a sample of 4073 patients diagnosed with OCD and/or PTSD enrolled in intensive treatment programs for OCD or PTSD, multigroup confirmatory factor analysis (MGCFA) and measurement invariance tests were run to determine the best fitting model of OCD and PTSD symptoms in patients with OCD+PTSD. Four models were compared across patients with OCD, PTSD, and OCD+PTSD: DSM-5 and 7-factor hybrid PTSD models with OCD symptoms structured as either combined or comorbid constructs. The comorbid hybrid model proved the best fit, and both hybrid models evidenced better fit than DSM-5 models. The current study lends additional support for the hybrid model of PTSD and suggests that there is no existence of a unique factor structure of OCD and PTSD symptoms in individuals with the comorbid conditions.

Impact of a Trauma-Informed Intervention for Youth and Staff on Rates of Violence in Juvenile Detention Settings

The majority of youth in the juvenile justice system have experienced multiple traumatic events in their lives, including community violence, physical abuse, neglect, and traumatic loss. These high prevalence rates, coupled with the known negative consequences of trauma in childhood and adolescence, have led to a greater emphasis on implementing trauma-informed services and practices within juvenile justice settings. However, although many stakeholders and government entities have expressed support for creating more trauma-informed juvenile justice systems, there is still limited empirical knowledge about which interventions are most effective at improving outcomes, particularly at the organizational or facility level. In an effort to fill this gap, the current study evaluated the impact of a trauma-informed milieu intervention, including skills training for youth and training for staff, on rates of violence at two secure juvenile detention facilities (N = 14,856) located in a large Northeastern city. The analyses revealed that the intervention was significantly related to a reduction of violent incidents in Facility A, with no impact on incidents in Facility B. Follow-up analyses revealed that a larger proportion of eligible youth in Facility A completed the skills group program as compared with eligible youth in Facility B (16% vs. 9%). This finding has important implications for the implementation of trauma-informed interventions for youth in juvenile detention settings, as it suggests that to impact outcomes at the facility level, a minimum threshold of youth may need to be exposed to the intervention. In addition, reductions in violence at Facility A were only realized after both staff training and youth skills components were implemented, suggesting that both components are necessary to create change at the facility level. Future research is needed to further explore the impact of organizational and implementation-level factors on trauma-informed care outcomes in juvenile justice settings.

Depression, anxiety, and drug usage history indicators among institutionalized juvenile offenders of Brasilia

INTRODUCTION

One of the most serious socio-educational measures for children and adolescents in conflict with the law in Brazil is their internment. This measure may represent an additional source of stress to this population and present significant impacts in the mental health context. This study aims to describe anxiety levels, depression, and addictive consumption, as well as to estimate the causalities and interactions of these variables.

METHODS

Herein, we report a study in which 175 male juveniles from youth detention institutions of the Federal District voluntarily completed the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and a short self-rating questionnaire asking whether and how often they had experienced cannabis, alcohol, and other "hard" psychotropic drugs (e.g., crack, cocaine, amphetamine) 1 year prior to institutionalization.

RESULTS

Of the total participants, 28.00% showed moderate to severe depression scores and 34.28% showed moderate to severe anxiety scores. In addition, the vast majority of participants also reported some antecedent drug abuse, including cannabis, alcohol, and other "hard drugs." The BDI scores moderately correlated with BAI, but none of these parameters considerably correlated with the antecedent drug abuse.

CONCLUSIONS

The data indicate potentially concerning levels of emotional distress in these institutionalized juveniles which seem to be independent of addictive behaviors. These data deserve attention and further investigation. Thus, a need for preventative mental health for the general population and socio-educational intervention aimed at interned youth which can decrease levels of emotional stress is emphasized.

Homicide as a Source of Posttraumatic Stress?: A Meta-Analysis of the Prevalence of Posttraumatic Stress Disorder After Committing Homicide

There is a growing body of literature on the diagnosis of posttraumatic stress disorder (PTSD) after committing homicide that has examined the prevalence of this phenomenon among individuals who have been convicted, but these studies considerably vary. The present study was the first meta-analysis to synthesize scientific evidence regarding the prevalence of offense-related PTSD among convicted killers. A total of 691 articles were identified through an initial screening process, and the final analysis included 11 studies that met the analysis criteria. We examined the prevalence of PTSD after committing homicide and explored how these rates varied by sample type, offender type, diagnosis timeframe, and diagnosis type. Among adult offenders, the pooled prevalence was 42.6%, 95% CI [38.0%, 47.4%], for current full-criteria homicide-related PTSD and 13.1%, 95% CI [9.9%, 17.2%], for current partial-criteria homicide-related PTSD. For mixed offenders (i.e., killers and violent offenders), the pooled prevalence of current full-criteria offense-related PTSD was 33.1% (95% CI [14.1, 59.8]). Thus, we found that PTSD prevalence was higher in killers than mixed offenders, although this difference was not statistically significant. Finally, among youth mixed offenders, the pooled prevalence for current full-criteria offense-related PTSD was 5.3%, 95% CI [2.9%, 9.5%]. These findings provide evidence of the high rate of this phenomenon, especially among convicted adults.

Associations Between PTSD Symptom Custers and Longitudinal Changes in Suicidal Ideation: Comparison Between 4-Factor and 7-Factor Models of DSM-5 PTSD Symptoms

Objective: The association between posttraumatic stress disorder (PTSD) and suicidal ideation (SI) is well-known. However, a few studies have investigated the associations between PTSD symptom clusters based on the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) and changes in suicide risk longitudinally. Methods: We adopted a longitudinal study design using data from the National Survey for Stress and Health of 3,090 of the Japanese population. The first and second surveys were conducted on November 2016 and March 2017, respectively. The suicidal ideation attributes scale was applied to assess the severity of suicidal ideation at baseline and the follow-up period. A multivariate linear regression model was conducted to examine the associations between the 4- or 7-factor model of PTSD symptom clusters at baseline and longitudinal changes in SI. Results: Overall, 3,090 subjects were analyzed (mean age, 44.9 ± 10.9 years; 48.8% female) at Baseline, and 2,163 completed the second survey. In the 4-factor model, we found that the severity of negative alternations in cognition and mood were significantly associated with increased SI after 4 months. In the 7-factor model, we found that the severity of anhedonia and externalizing behavior at baseline was significantly associated with increased SI during the follow-up period. Conclusions: We found that the seven-factor model of DSM-5 PTSD symptoms may provide greater specificity in predicting longitudinal SI change in the general population. Closely monitoring specific PTSD core symptoms may be more effective in mitigating key clinical and functional outcomes.

Posttraumatic Stress Symptoms and Recidivism in Serious Juvenile Offenders: Testing the Mediating Role of Future Orientation

Evidence suggests delinquent youth are more likely to suffer from posttraumatic stress symptoms and links those symptoms to subsequent aggressive behavior and criminal activity. Research also indicates the impact of decision-making capacity in this context. Specifically, future orientation has been shown to play an important role in adolescent delinquency; less future orientation has been linked with persistent delinquency. Notably, trauma exposure is associated with slower development of future orientation in delinquent youth. Using a sample of serious juvenile offenders, the current study examined the relation between posttraumatic stress symptoms and aggressive reoffending testing the hypothesis that future orientation would mediate that relation. Results did not indicate significant mediation by future orientation in the link between posttraumatic stress symptoms and aggressive reoffending. However, experiencing posttraumatic stress symptoms and low future orientation separately increased the likelihood of aggressive recidivism. Findings highlight the value of comprehensive prevention and intervention efforts, targeting both posttraumatic stress symptoms and future orientation.

Comparing mental health disorders among sex trafficked children and three groups of youth at high-risk for trafficking: A dual retrospective cohort and scoping review

BACKGROUND

Individuals at high-risk for trafficking are often subject to preexisting complex trauma that only intensifies during the trafficking experience. This greatly increases their risk of mental illness, although the actual prevalence of mental health disorders in children who are sex trafficked remains unclear.

OBJECTIVE

To examine the prevalence of mental health diagnoses among a sample of youth identified as being sex trafficked, and to discuss these rates in relation to other high-risk groups reported in the literature.

PARTICIPANTS AND SETTING

143 female and male child trafficking victims in Wisconsin.

METHODS

We retrospectively reviewed individual medical records, identifying mental health diagnoses and behaviors. The results were compared to summarized prevalence data for mental health disorders in sex trafficked, runaway children, juvenile offenders, and foster care children identified via a scoping review.

RESULTS

We observed significantly higher rates of ADHD (52.4%, p < 0.0001), bipolar disorder (26.6%, p < 0.0001), and PTSD (19.6%, p < 0.05 to p < 0.0001) in our sample of trafficked youth compared to all high-risk groups, as well as for depression (45.5%), anxiety (19.6%), conduct disorder (19.6%), ODD (25.9%), and psychosis (14.0%) relative to multiple groups individually.

CONCLUSIONS

The complex trauma suffered by child survivors of sex trafficking can impart numerous effects with overlapping symptomatology of many mental health disorders. Survivors' adaptive responses to complex trauma may lead to improper diagnosis and treatment of mental health disorders at the expense of prompt access to trauma-focused therapies. Alternative diagnoses and treatments of this complex dysfunction are discussed.

Post-traumatic stress and related symptoms among juvenile detention residents: Results from intake screening

BACKGROUND

Juvenile justice-involved youth have high rates of trauma exposure, physical and sexual abuse and PTSD. Several factors have been found to be related to PTSD symptoms in youth including number and chronicity of traumatic events.

OBJECTIVE

To simultaneously examine the relationships between allostatic load (defined here as number of traumatic experiences), poly-victimization (exposure to two or more forms of victimization based on 5 of the 6 categories in Ford et al.'s 2010 study), physical/sexual abuse and PTSD in justice-involved youth.

PARTICIPANTS AND SETTING

The sample consisted of 1984 youth in juvenile detention in a Northeastern city. The sample was 73.4% male and the majority of youth were either African American or Hispanic.

METHODS

Clinicians collected demographic and psychosocial information, and measured symptoms of PTSD, depression, and problematic substance use.

RESULTS

Results showed that youth with more traumas, those who experienced poly-victimization and those who experienced physical/sexual assault/abuse were not only more likely to have PTSD, but also more likely to have depression, thoughts of suicide/self-harm, and problematic substance use (as indicated by the presence of 2 or more of 6 possible indicators). Poly-victimization was a stronger correlate of PTSD than number of traumas or physical/sexual assault/abuse. However, among youth with PTSD, number of traumas was associated with co-occurring problems while poly-victimization and physical/sexual assault/abuse were not.

CONCLUSIONS

Findings can be used to help direct resources to juvenile justice-involved youth who are most in need of treatment.

Emotional Reactivity and Antisocial Behavior Relative to Posttraumatic Stress Symptom Expression: a Latent Profile Analysis

This study examined whether emotional reactivity was associated with violent juvenile offending in a sample of detained boys (N = 198). It was predicted that Latent Profile Analysis (LPA) would reveal a "low reactivity" group, characterized by symptoms of emotional numbing and callous-unemotional (CU) traits, and a "high reactivity" group, characterized by symptoms of hyperarousal and emotional dysregulation. It was hypothesized that the low reactivity group would have higher rates of violent offending and proactive aggression than the high reactivity group. Contrary to expectations, results indicated that the presence of both emotional numbing and hyperarousal symptoms, but not hyperarousal symptoms alone, were associated with higher rates of violent offending, CU traits, and proactive aggression. Results indicate that the risk of serious aggressive behavior and violent offending may be highest among youth who are easily provoked to respond aggressively (i.e., hyperarousal symptoms) while simultaneously able to maintain emotional detachment (i.e., elevated emotional numbing symptoms and CU traits).

Implementing Trauma-Informed Practice in Juvenile Justice Systems: What can Courts Learn from Child Welfare Interventions?

Many youth entering juvenile court systems show manifestations of psychological trauma. Focusing on rural juvenile courts, systems with greatly underserved and under-researched populations, we assessed practices, barriers, and recommendations around trauma-informed practice, an evidence-based approach for addressing trauma and reducing delinquent behavior and recidivism. As part of a pilot trauma-informed practice initiative at four rural Michigan juvenile courts, semi-structured qualitative interviews were conducted with 15 court staff, including probation officers, referees, judges, and on-site clinical therapists. Respondents expressed an ideological affinity for trauma-informed practice, describing growing inclinations to rely on referral-making around mental health treatment in lieu of traditional (punitive) sentencing. Key implementation barriers included limited access to local mental health resources, insufficient buy-in from K-12 schools, government, and police, and concerns over professional abilities/boundaries. Respondents recommended additional technical trainings on trauma-informed practice and cross-disciplinary education for clients' families and external stakeholders.

Development and Evaluation of the Dutch Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)

Background: In 2013, the Clinician-Administered PTSD Scale, the golden standard to assess PTSD, was adapted to the DSM-5 (CAPS-5). Objective: This project aimed to develop a clinically relevant Dutch translation of the CAPS-5 and to investigate its psychometric properties. Method: We conducted a stepped translation including Delphi rounds with a crowd of 44 Dutch psychotrauma experts and five senior psychotrauma experts. Using partial crowd-translations, two professional translations and the official Dutch translation of the DSM-5, each senior expert aggregated one independent translation. Consensus was reached plenary. After back-translation, comparison with the original CAPS-5 and field testing, a last round with the senior experts resulted in the final version. After implementation clinicians conducted CAPS-5 interviews with 669 trauma-exposed individuals referred for specialized diagnostic assessment. Reliability of the Dutch CAPS-5 was investigated through internal consistency and interrater reliability analyses, and construct validity through confirmatory factor analysis (CFA). Results: CAPS-5 total severity score showed high internal consistency (α = .90) and interrater reliability (ICC = .98, 95% CI: .94-.99). CAPS-5 diagnosis showed modest interrater reliability (kappa = .59, 95% CI: .20-.98). CFA with alternative PTSD models revealed adequate support for the DSM-5 four-factor model, but a six-factor (Anhedonia) model fit the data best. Conclusions: The Dutch CAPS-5 is a carefully translated instrument with adequate psychometric properties. Current results add to the growing support for more refined (six and seven) factor models for DSM-5 PTSD indicating that the validity and clinical implications of these models should be objective of further research.

Construct validation of the hybrid model of posttraumatic stress disorder: Distinctiveness of the new symptom clusters

Despite the factor analytic support for the seven-factor hybrid model (Armour et al., 2015) of posttraumatic stress disorder (PTSD), little research has examined the degree to which newly established symptom clusters (i.e., negative affect, anhedonia, dysphoric arousal, anxious arousal, externalizing behavior) functionally and meaningfully differ in their associations with other clinical phenomena. The aim of the current study was to examine the degree to which newly established PTSD symptom clusters differentially relate to co-occurring psychopathology and related clinical phenomena through Wald testing using latent variable modeling. Participants were 535 trauma-exposed undergraduates who completed the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5; Weathers et al., 2013) and Personality Assessment Inventory (PAI; Morey, 1991). As expected and in line with results from previous studies, significant heterogeneity emerged for dysphoric arousal, anxious arousal, and externalizing behavior. However, there was less evidence for the distinctiveness of negative affect and anhedonia. Results indicate that only some of the newly established symptom clusters significantly differ in their associations with related clinical phenomena and that the hybrid model might not provide a meaningful framework for understanding which PTSD symptoms relate to associated features. Limitations include a non-clinical sample and reliance on retrospective self-report assessment measures.

Posttraumatic Stress and Youth Violence Perpetration: a Population-Based Cross-Sectional Study

Background

Exposure to trauma was found to increase later violent behaviours in youth but the underlying psychopathological mechanisms are unclear. This study aimed to test whether posttraumatic stress disorder (PTSD) is related to violent behaviours and whether PTSD symptoms mediate the relationship between the number of trauma experiences and violent behaviours in adolescents.

Method

The present study is based on a nationally representative sample of 9th grade students with 3434 boys (mean age = 15.5 years) and 3194 girls (mean age = 15.5 years) in Switzerland. Lifetime exposure to traumatic events and current PTSD were assessed by the use of the University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index (UCLA-RI). Logistic regression was used to assess associations between PTSD and violent behaviours, and structural equation modelling (SEM) was used to examine the meditation effects of PTSD.

Results

PTSD (boys: OR = 7.9; girls: OR = 5.5) was strongly related to violent behaviours. PTSD symptoms partially mediated the association between trauma exposure and violent behaviours in boys but not in girls. PTSD symptoms of dysphoric arousal were positively related to violent behaviours in both genders. Anxious arousal symptoms were negatively related to violent behaviours in boys but not in girls.

Conclusions

In addition to trauma, posttraumatic stress is related to violent outcomes. However, specific symptom clusters of PTSD seem differently related to violent behaviours and they do not fully explain a trauma-violence link. Specific interventions to improve emotion regulation skills may be useful particularly in boys with elevated PTSD dysphoric arousal in order to break up the cycle of violence.

Social Ecological Determinants of Substance Use Treatment Entry Among Serious Juvenile Offenders From Adolescence Through Emerging Adulthood

PURPOSE

To examine the social-ecological determinants of substance use treatment entry among serious juvenile offenders over a 7 year period. Using the social-ecological framework, relevant predictors of substance use from the literature were used to assess risk (and protective) factors at the individual, parental, peer and neighborhood level.

METHOD

Serious juvenile offenders (N=1354, M_{age baseline}=16.0 years, SD=1.14) were prospectively followed over 7 years (M_{age Conclusion}=23.0 years, SD=1.15). Cox regression with time invariant and time varying predictors was used to predict time to first substance use treatment entry.

RESULTS

Results for each dimension, separately, varied slightly from the full model. In the full model peer delinquency, peer arrests, post-traumatic stress disorder (PTSD), impulse control, temperament, and emotional regulation remained salient risk (and protective) factors for treatment entry.

CONCLUSION

Associating with more deviant peers and having more of your peers arrested over the 7 year study period was associated with substantial increase in time to treatment entry. Furthermore, one of the strongest risk factors for treatment entry was a PTSD diagnosis. Treatment implications are discussed regarding peer affiliation and PTSD symptomology as well as potential neurological and biological contributors to increased risk for treatment entry.

Research Review: Changes in the prevalence and symptom severity of child post-traumatic stress disorder in the year following trauma - a meta-analytic study

BACKGROUND

Understanding the natural course of child and adolescent posttraumatic stress disorder (PTSD) has significant implications for the identification of, and intervention for, at-risk youth. We used a meta-analytic approach to examine longitudinal changes in youth PTSD prevalence and symptoms over the first 12 months posttrauma.

METHODS

We conducted a systematic review to identify longitudinal studies of PTSD in young people (5-18 years old), excluding treatment trials. The search yielded 27 peer-reviewed studies and one unpublished dataset for analysis of pooled prevalence estimates, relative prevalence reduction and standardised mean symptom change. Key moderators were also explored, including age, proportion of boys in the sample, initial prevalence of PTSD and PTSD measurement type.

RESULTS

Analyses demonstrated moderate declines in PTSD prevalence and symptom severity over the first 3-6 months posttrauma. From 1 to 6 months posttrauma, the prevalence of PTSD reduced by approximately 50%. Symptoms also showed moderate decline, particularly across the first 3 months posttrauma. There was little evidence of further change in prevalence or symptom severity after 6 months, suggesting that it is unlikely a child would lose a PTSD diagnosis without intervention beyond this point.

CONCLUSIONS

The current findings provide key information about the likelihood of posttrauma recovery in the absence of intervention and have important implications for our understanding of child and adolescent PTSD. Results are discussed with reference to the timing of PTSD screening and the potential role of early interventions. Findings particularly highlight the importance of future research to develop our understanding of what factors prevent the action of normal recovery from the 'acute' posttrauma period.

Involvement in the Juvenile Justice System for African American Adolescents: Examining Associations with Behavioral Health Problems

While researchers have found that African American youth experience higher levels of juvenile justice involvement at every system level (arrest, sentencing, and incarceration) relative to their other ethnic counterparts, few studies have explored how juvenile justice involvement and number of contacts might be correlated with this broad range of problems. A convenience sample of 638 African American adolescents living in predominantly low-income, urban communities participated in a survey related to juvenile justice involvement. Major findings using logistic regression models indicated that adolescents who reported juvenile justice system involvement versus no involvement were 2.3 times as likely to report mental health problems, substance abuse, and delinquent or youth offending behaviors. Additional findings documented that the higher the number of juvenile justice system contacts, the higher the rates of delinquent behaviors, alcohol and marijuana use, sex while high on drugs, and commercial sex. These findings suggest that identifying and targeting youth who have multiple juvenile justice system contacts, especially those in low-resourced communities for early intervention services, may be beneficial. Future research should examine whether peer network norms might mediate the relationships between juvenile justice involvement and youth problem behaviors.

Assessing post-traumatic stress symptoms in a Latino prison population

PURPOSE

The purpose of this paper is to assess the reliability and validity of the Spanish version of the Davidson trauma scale (DTS-S) and to determine the prevalence and correlates of post-traumatic stress disorder (PTSD) symptoms in a non-clinical random sample of prison inmates.

DESIGN/METHODOLOGY/APPROACH

Probabilistic samples of 1,179 inmates from 26 penal institutions in Puerto Rico were selected using a multistage sampling design. Population estimates and correlations were obtained for PTSD, generalized anxiety and depression. The reliability, factor structure, and convergent validity of the DTS-S were assessed. Cross-validation was employed to confirm the results of the factor analyses.

FINDINGS

Using the cut-offs adopted by the scale's author, 136 (13.4 percent) of the inmates are likely to have current PTSD and 117 (11.6 percent) reach the cut-off for sub-threshold PTSD. Confirmatory factor analysis generated two factors explaining 53 percent of the variance. High reliabilities were obtained for the total scale (α=0.95) and for the frequency and severity scales (α=0.90 and 0.91). Significantly higher DTS-S scores were found for females (t=2.26, p<0.025), for inmates diagnosed with depression or anxiety (t=2.02, p<0.05), and those reporting suicide attempts (t=4.47, p<0.0001).

ORIGINALITY/VALUE

Findings support that the DTS-S is a reliable and valid measure to assess PTSD symptoms in Latino inmate populations and to identify individuals at risk for the disorder that require confirmatory diagnosis and clinical interventions.

Trauma-focused treatment in a state system of care: is it worth the cost?

The efficacy of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in treating child traumatic stress inspires nationwide dissemination, yet widespread adoption by state systems of care is lagging. A significant barrier is the cost of implementation and maintenance of evidence-based services. Thus, the current study examined the annual costs of mental health services accrued for 90 publiclyinsured, trauma-exposed children from the time they began participation in a TF-CBT implementation project to 1 year after their admission. These costs were compared to those accrued over that same time period by 90 trauma-exposed control children that were matched by demographics and prior mental health services utilization using a propensity score matching algorithm and provided outpatient treatment as usual. Results indicated that (a) 27.5 % of the total cost was attributed to high-end services utilized by only 1.67 % of children; (b) two times more money was spent on low-end mental health services received by the TF-CBT group than the control group, and (c) five times more money was spent on high-end mental health services received by the control group than the TF-CBT group in that year. These data suggest that providing evidence-based trauma-focused outpatient treatment to children with trauma-related problems may offset the eventual need for services that are more restrictive and costly.

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.

Poly-Victimization Among Girls in the Justice System

Life History Calendars and the Juvenile Victimization Questionnaire were used to collect data from 100 delinquent girls to (a) examine range and co-occurrence of different types of violence over the life span, (b) examine independent and cumulative trajectories of risk for varied types of victimization, and (c) examine the relationship of victimization to girls’ offending. Risk trajectories demonstrate critical risk periods for different forms of violence exposure. Cox regression was used to examine the predictive value of different forms of violence exposure for the onset of delinquent and criminal behavior. Findings illuminate the need for programs addressing substance use and alternative coping mechanisms.

Dimensional structure of DSM-5 posttraumatic stress symptoms: support for a hybrid Anhedonia and Externalizing Behaviors model

Several revisions to the symptom clusters of posttraumatic stress disorder (PTSD) have been made in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Central to the focus of this study was the revision of PTSD's tripartite structure in DSM-IV into four symptom clusters in DSM-5. Emerging confirmatory factor analytic (CFA) studies have suggested that DSM-5 PTSD symptoms may be best represented by one of two 6-factor models: (1) an Externalizing Behaviors model characterized by a factor which combines the irritability/anger and self-destructive/reckless behavior items; and (2) an Anhedonia model characterized by items of loss of interest, detachment, and restricted affect. The current study conducted CFAs of DSM-5 PTSD symptoms assessed using the PTSD Checklist for DSM-5 (PCL-5) in two independent and diverse trauma-exposed samples of a nationally representative sample of 1484 U.S. veterans and a sample of 497 Midwestern U.S. university undergraduate students. Relative fits of the DSM-5 model, the DSM-5 Dysphoria model, the DSM-5 Dysphoric Arousal model, the two 6-factor models, and a newly proposed 7-factor Hybrid model, which consolidates the two 6-factor models, were evaluated. Results revealed that, in both samples, both 6-factor models provided significantly better fit than the 4-factor DSM-5 model, the DSM-5 Dysphoria model and the DSM-5 Dysphoric Arousal model. Further, the 7-factor Hybrid model, which incorporates key features of both 6-factor models and is comprised of re-experiencing, avoidance, negative affect, anhedonia, externalizing behaviors, and anxious and dysphoric arousal symptom clusters, provided superior fit to the data in both samples. Results are discussed in light of theoretical and empirical support for the latent structure of DSM-5 PTSD symptoms.

California State Hospital Violence Assessment and Treatment (Cal-VAT) guidelines

Here we provide comprehensive guidelines for the assessment and treatment of violence and aggression of various etiologies, including psychotic aggression and impulsive aggression due to schizophrenia, mood disorders, ADHD, or trauma, and predatory aggression due to psychopathy and other personality disorders. These guidelines have been developed from a collection of prescribing recommendations, clinical trial results, and years of clinical experience in treating patients who are persistently violent or aggressive in the California Department of State Hospital System. Many of the recommendations provided in these guidelines employ off-label prescribing practices; thus, sound clinical judgment based on individual patient needs and according to institution formularies must be considered when applying these guidelines in clinical practice.

Crime and psychiatric disorders among youth in the US population: an analysis of the National Comorbidity Survey-Adolescent Supplement

OBJECTIVE

Current knowledge regarding psychiatric disorders and crime in youth is limited to juvenile justice and community samples. This study examined relationships between psychiatric disorders and self-reported crime involvement in a sample of youth representative of the US population.

METHOD

The National Comorbidity Survey-Adolescent Supplement (N = 10,123; ages 13-17 years; 2001-2004) was used to examine the relationship between lifetime DSM-IV-based diagnoses, reported crime (property, violent, other), and arrest history. Logistic regression compared the odds of reported crime involvement with specific psychiatric disorders to those without any diagnoses, and examined the odds of crime by psychiatric comorbidity.

RESULTS

Prevalence of crime was 18.4%. Youth with lifetime psychiatric disorders, compared to no disorders, had significantly greater odds of crime, including violent crime. For violent crime resulting in arrest, conduct disorder (CD) (odds ratio OR = 57.5; 95% CI = 30.4, 108.8), alcohol use disorders (OR = 19.5; 95% CI = 8.8, 43.2), and drug use disorders (OR = 16.1; 95% CI = 9.3, 27.7) had the greatest odds with similar findings for violent crime with no arrest. Psychiatric comorbidity increased the odds of crime. Youth with 3 or more diagnoses (16.0% of population) accounted for 54.1% of those reporting arrest for violent crime. Youth with at least 1 diagnosis committed 85.8% of crime, which was reduced to 67.9% by removing individuals with CD. Importantly, 88.2% of youth with mental illness reported never having committed any crime.

CONCLUSION

Our findings highlight the importance of improving access to mental health services for youthful offenders in community settings, given the substantial associations found between mental illness and crime in this nationally representative epidemiological sample.

Lifetime exposure to traumatic events among adolescents in contact with the Nigerian juvenile justice systems compared with a comparison group of secondary school students

BACKGROUND

There are some knowledge gaps in what is known about pre-contact exposure to traumatic events among adolescents within the juvenile justice system. Data often focus on psychological sequelae without describing the traumatic events. In addition, there are few data from sub-Saharan Africa where juvenile justice inmates are often minor offenders and may themselves have been victims of abuse and neglect.

OBJECTIVE

To present detailed data on the lifetime prevalence rate and pattern of traumatic events among a cohort of adolescents in juvenile justice custody in Nigeria and to compare inmates who are 'offenders' with those who are 'victims'.

METHODS

Inmates of a borstal and a remand home comprised the study group and age- and gender-matched adolescents from two government schools were the secondary comparison group. The trauma-checklist of the Current and Lifetime Version of the Kiddies Schedule for Affective Disorders and Schizophrenia was used as a guide in assessing traumatic events.

RESULTS

Of a total of 408 adolescents, 204 were recruited from the two juvenile justice institutions and 204 from secondary schools. Ninety per cent of participants were male and the mean (SD) age was 15·9 (2·8) years. The prevalence rate of lifetime exposure to traumatic events among the juvenile justice offenders was 88·7% compared with 48·5% of the comparison group (P = 0·001). The most commonly reported specific lifetime traumatic event was physical abuse (52·8%). The institutionalised adolescents were significantly more likely to report lifetime exposure to almost all the traumatic events assessed. Apart from the perpetrators of violent crime, there was no statistically significant difference in the prevalence and pattern of lifetime exposure to traumatic events between the offenders and the victims.

CONCLUSIONS

This study provides further evidence that exposure to traumatic events is a fact of life for inmates of juvenile institutions, irrespective of whether they are offenders or victims. The implications for reform of the Nigerian juvenile justice system are discussed.

Posttraumatic stress among youths in juvenile detention

An estimated 1.8 million juveniles were arrested in the United States for delinquency in 2009. Previous studies indicate high rates of exposure to traumatic events and posttraumatic stress (PTS) symptoms for these youths. This study examined PTS in a sample of 170 youths in juvenile detention. The results of this study reveal higher rates of PTS symptoms (21%) compared to national rates (6%). The data also suggest youths suffering from more PTS symptoms also report higher depression, anxiety, anger, family relationship worries, thought problems, and attention problems. These factors provide a direction for continued practice targeting these youths.

Building a consumer base for trauma-focused cognitive behavioral therapy in a state system of care

This paper documents the scope and limitations of an outreach effort to build a consumer base for Trauma-focused cognitive behavioral therapy in a state public mental health system for children. Three key aspects are discussed: the fostering of an informed referral network, the development of screening and identification services, and the engagement of families. Referral, screening and engagement are each examined against the backdrop of existing literature on implementation and dissemination. Each aspect of the implementation plan is described in detail-as are the barriers encountered and lessons learned during the course of execution. We provide several recommendations to assist other efforts to implement Evidence-Based Treatments into state systems of care.

Cross-cultural findings on community violence exposure and internalizing psychopathology: comparing adolescents in the United States, Russia, and Belgium

The study aimed to investigate cross-cultural differences in the relation between community violence and psychopathology. A self-report survey was conducted in a representative sample of 3,309 14-17 year old adolescents from urban communities in the US (N = 1,343), Belgium (N = 946) and Russia (N = 1,009). In all three countries, boys reported higher prevalences of violence exposure and more victimization by community violence than girls. Controlling for involvement in antisocial behavior, levels of psychopathology increased along with severity of exposure to community violence (from no exposure to witnessing to victimization). The associations between community violence and internalizing problems were similar across countries and gender. Current findings suggest that the relationships between community violence and adolescent mental health are not culture bound and that they follow similar dynamics in different populations. Clinical implications and directions are discussed.

Youth pathways to placement: the influence of gender, mental health need and trauma on confinement in the juvenile justice system

Although the juvenile crime rate has generally declined, the involvement of girls in the juvenile justice system has been increasing. Possible explanations for this gender difference include the impact of exposure to trauma and mental health needs on developmental pathways and the resulting influence of youth's involvement in the justice system. This study examined the influence of gender, mental health needs and trauma on the risk of out-of-home placement for juvenile offenders. The sample included youth referred to three urban juvenile probation departments in Texas between January 1, 2007 and December 31, 2008 and who received state-mandated mental health screening (N = 34,222; 30.1 % female). The analysis revealed that, for both genders, elevated scores on the seven factor-analytically derived subscales of a mental health screening instrument (Alcohol and Drug Use, Depressed-Anxious, Somatic Complaints, Suicidal Ideation, Thought Disturbance, and Traumatic Experiences), especially related to past traumatic experiences, influenced how deeply juveniles penetrated the system. The findings suggest that additional research is needed to determine the effectiveness of trauma interventions and the implementation of trauma informed systems for youth involved with the juvenile justice system.

Social Problem Solving and Aggression: The Role of Depression

The purpose of the present study was to examine direct and indirect relations among social problem-solving, depression, and aggression, as well as the mediating role of depression in the link between social problem-solving and aggression among Turkish youth. Data for the present study were collected from 413 adolescents. The participants’ age ranged from 14 to 17 with a mean of 15.74 years (SD = .97). Results indicated that social problem-solving was significantly and negatively associated with both depression and aggression. Also, depression significantly and positively associated with aggression and depression appears to act as a mediator in the relationship between social problem-solving and aggression. Findings suggest that social problem-solving and depression are important factors in understanding aggression among Turkish youth.

Personality and psychopathology in African unaccompanied refugee minors: repression, resilience and vulnerability

Examining personality and psychopathological symptoms among unaccompanied refugee minors (URMs), we measured intra-individual dimensions (repression and correlates thereof) usually associated with resilience. Forty-one URMs completed the Weinberger Adjustment Inventory (WAI), assessing personality, and the Youth Self-Report (YSR), describing current symptoms. URMs endorsed high levels of Repressive Defensiveness, Denial of Distress, and Restraint; unexpectedly, URMs reported high Distress and reduced Happiness (WAI, p's < 0.05). Although YSR symptoms were below clinical cut points, there were notable correlations between Distress and Attention Problems, Self-destructive, and Aggressive Behavior (all on the YSR), correcting for multiple comparisons (p's < 0.004). URMs exposed to non-normative stressors reported non-symptomatic outcomes, and high levels of personality dimensions correlating with resilience. However, URMs also endorsed high Distress and low Happiness, calling their resilience into question. Positive correlations between WAI Distress and YSR symptom subscales suggest that URMs harbor vulnerabilities of clinical and forensic significance.

Trauma History and PTSD Symptoms in Juvenile Offenders on Probation

Detained and incarcerated juveniles are found to have heightened rates of trauma and posttraumatic stress disorder (PTSD). Less is known about probation youth, who represent the majority of juveniles in the criminal justice system. This study examined trauma history and PTSD and associations with behavioral health problems among 13-17 year-old juveniles on probation (N=61). Most (93%) reported at least one traumatic event, and 12% met diagnostic criteria for PTSD. Trauma exposure and PTSD symptoms were associated with mental health problems but not substance use or risky sexual behavior. Findings underscore the importance of addressing trauma history in probation youth.

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

CONTEXT

Psychiatric disorders are prevalent among incarcerated juveniles. Most juveniles eventually return to their communities, where they become the responsibility of the community mental health system. However, no large-scale study has examined psychiatric disorders after youth leave detention.

OBJECTIVE

To examine changes in the prevalence and persistence of psychiatric disorders during the 5 years after detention, focusing on sex and racial/ethnic differences.

DESIGN

Prospective longitudinal study with up to 5 interviews (1829 youth: 1172 males and 657 females). To ensure representation of key demographic subgroups, the randomly selected sample was stratified by sex, race/ethnicity (African American, non-Hispanic white, and Hispanic), age, and legal status (juvenile or adult court).

SETTING

The Northwestern Juvenile Project, sampling youth from the Cook County Juvenile Temporary Detention Center, Chicago, Illinois.

PARTICIPANTS

Detained youth, aged 10 to 18 years at baseline interview.

MAIN OUTCOME MEASURES

At baseline, the Diagnostic Interview Schedule for Children Version 2.3. At follow-up interviews, 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 baseline, more than 45% of males and nearly 30% of females had 1 or more psychiatric disorders with associated impairment. More than 50% of males and more than 40% of females had 1 or more psychiatric disorders without impairment. Substance use disorders were the most common; males, however, had higher rates over time (5 years after baseline, adjusted odds ratio [AOR], 2.61; 95% CI, 1.96-3.47). Non-Hispanic whites and Hispanics also had higher rates of substance use disorders vs African Americans (AOR, 1.96; 95% CI, 1.54-2.49 and AOR, 1.59; 95% CI, 1.24-2.03). Females had higher rates of major depression over time (AOR, 1.59; 95% CI, 1.22-2.08).

CONCLUSIONS

Although prevalence rates of most psychiatric disorders declined as youth aged, a substantial proportion of delinquent youth continue to have disorders. There are notable sex and racial/ethnic differences in the prevalence and persistence of psychiatric disorders in this population.

The Missing Link between Juvenile Delinquency and Pediatric Posttraumatic Stress Disorder: An Attachment Theory Lens

The present paper reviews pediatric posttraumatic stress disorder, emphasizing the relational basis of the disorder and highlighting the missing link between juvenile delinquency and trauma. The first part of the paper defines trauma and the diagnostic criteria for PTSD, noting child-specific features. The second part reviews the literature emphasizing the relational and attachment relevant nature of trauma. The third part explores psychological mechanisms for how attachment relations could affect trauma responses. Attachment relations (1) shape core schemas of the world, others, and the self and (2) foster emotional engagement or disengagement, both of which have been associated with traumatic responses. The most empirically supported pediatric trauma treatment, trauma-focused cognitive behavioral therapy (TF-CBT), acknowledges the attachment figure's influence and includes treating and training the parent and conjoint child-parent discussion. The next section reviews the noteworthy link between juvenile delinquency and trauma history. More awareness of trauma and PTSD in children and adolescents is recommended to effectively address juvenile delinquency. The review ends with a few helpful points for practicing pediatricians regarding childhood trauma.

Randomized trial comparison of emotion regulation and relational psychotherapies for PTSD with girls involved in delinquency

Posttraumatic stress disorder (PTSD) is prevalent in youth involved in delinquency, but it is often not effectively treated. A randomized clinical trial was conducted comparing the outcomes of an emotion regulation therapy (Trauma Affect Regulation: Guide for Education and Therapy, or TARGET) with a relational supportive therapy (Enhanced Treatment as Usual, or ETAU) with 59 delinquent girls (age 13-17 years) who met criteria for full or partial PTSD. Mixed model regression analyses demonstrated generally large effects for pre-post change in PTSD symptoms for both therapies but not in emotion regulation. Both therapies had small to medium effect size changes in anxiety, anger, depression, and posttraumatic cognitions. Treatment × Time interactions showed small to medium effects favoring TARGET for change in PTSD (intrusive reexperiencing and avoidance) and anxiety symptoms, posttraumatic cognitions, and emotion regulation, and favoring ETAU for change in hope and anger. Results provide preliminary support for TARGET as a potentially efficacious therapy for PTSD with delinquent girls. Relational therapies such as ETAU also may be beneficial for delinquent girls with PTSD, particularly to enhance optimism and self-efficacy and reduce anger.

Psychopathy and traumatic stress

This study examined the relationship between psychopathy and traumatic stress. First, a sample of 48 male patients in a security hospital was assessed using the Psychopathy Checklist (Hare, 2003) and the Stanford Acute Stress Reactions Questionnaire (SASRQ; Cardena, Classen, Koopman, & Spiegel, 1996). Linear regression analyses suggested that the affect deficit component of psychopathy was the best negative predictor of avoidance, dissociation, and re-experiencing symptoms. The 13 highest-scoring psychopathy participants were then compared to the 13 lowest-scoring participants. Psychopaths differed from controls in terms of number but not type of traumatic events. They obtained significantly lower SASRQ total score, reflecting a lower level of traumatic symptomatology. The results are discussed in connection with the emotional deficit component of psychopathy.

Symptomatic response to divalproex in subtypes of conduct disorder

To investigate response to Divalproex sodium (DVPX) with respect to Reactive/Affective/Defensive/Impulsive (RADI) and Proactive/Instrumental/Premeditated (PIP) aggression among adolescent males with conduct disorder (CD), using results from a randomized, double-blind, placebo-controlled trial. It was hypothesized that DVPX response among participants with RADI aggression would be greater than among those with PIP aggression. Fifty-eight ethnically diverse males with severe CD were assigned to High Distress (HDCD) or Low Distress (LDCD) Conduct Disorder, corresponding with RADI and PIP aggression, respectively. Following a 1-week washout, all subjects were randomized to a high dose (up to 1,500 mg/day) or low dose (up to 250 mg/day) of DVPX. Baseline and endpoint assessments included Clinical Global Impression (CGI), Achenbach Self Report (YSR), and Weinberger Adjustment Inventory (WAI-62). Response to DVPX was significantly higher in the HDCD group (64%) than in the LDCD group (22%) in the high-dose treatment group (p = 0.03). Mean weekly WAI-62 distress scores declined significantly among the HDCD subjects than among LDCD subjects in the high-dose group. These results support the utility of mood stabilizing agents such as DVPX in treating patients with disorders characterized by the RADI pattern of aggression, including those with severe CD.

[Prevalence of psychiatric disorders in juvenile offenders in the city of Rio de Janeiro (RJ, Brazil)]

The prevalence of juvenile offenders in Brazil, mainly among young females, is on the increase. The literature on this issue indicates an increased incidence of mental disorders among young offenders in several countries, though studies in Brazil are lacking. The aim of this article is to study the prevalence of mental disorders in adolescents from a socio-educational standpoint, taking as a hypothesis the gender difference and the type of offense committed. The instrument used was the K-SADS-PL. As results, we found a high prevalence of psychiatric disorders among juvenile offenders, the most common being: attention deficit hyperactivity disorder (33.3%); behavioral disorder (77%); oppositional defiant disorder (50%), anxiety disorders (70%), depressive disorder (50%), illicit drug abuse/dependence (70%), and alcohol abuse/dependence (52%). Alcohol abuse/dependence caused a 2.4-fold increase in the probability of adolescents committing a violent offence. Public health authorities should concentrate on early diagnosis and treatment of psychiatric disorders in childhood to reduce future violations. It is also suggested that mental health treatment of detained juveniles should be a fundamental part of the recuperation and reintegration of young offenders into society.

Contributors to traumatic exposure and posttraumatic stress disorder in juvenile justice youths

This study considers demographic, offense, and disorder contributors to exposure and posttraumatic stress disorder (PTSD) in a large (N = 9,611) dataset of standardized psychiatric assessments resulting from nationwide collaborations with justice agencies. Youths' antisocial history may elevate risk for traumatic exposure and PTSD; additionally, traumatic victimization increases risk for externalizing behavior. Rates of all types of traumatic exposure and PTSD were clearly elevated and expectably related to disorder and antisocial behavior. Males were significantly more likely than females to report assaultive violence, whereas females were significantly more likely than males to report forced sexual activity. Gender interactions with disorder and antisocial behavior were contributory only in predicting forced sexual activity: females' exposure was not conditional on features characterizing males' exposure. Findings highlight the high levels of trauma exposure at all levels of juvenile justice processing, and the particular vulnerability of males with internalizing psychopathology. Consistent with increased recent interest in the diagnosis of developmental trauma disorder, and given the likely interconnectedness between traumatic exposure and externalizing symptoms, treatment approaches for justice youths should address their co-occurrence.

Psychopathologische und komorbide Störungen inhaftierter Jugendlicher in Österreich

Fragestellung: Inhaftierte Jugendliche zeigen hohe Prävalenzraten an psychiatrischen Störungen und gehäuft psychiatrische Komorbidität. Im Strafvollzug tätige Kinder- und JugendpsychiaterInnen stehen vor der Versorgungsaufgabe und der Notwendigkeit, störungsspezifische Behandlungsansätze auszuarbeiten. Die in dieser Studie erhobenen psychiatrischen Störungen bei inhaftierten Jugendlichen wurden im Hinblick auf störungsspezifische Behandlungsaspekte geschlechtsspezifisch ausgewertet. Methodik: Das Mini International Neuropsychiatric Interview für Kinder und Jugendliche wurde angewandt, um die Psychopathologie bei in Österreich inhaftierten Jugendlichen zu erheben. Die endgültige Stichprobe umfasste 333 Jugendliche (58 Mädchen und 275 Jungen). Ergebnisse: 90 % der inhaftierten Jugendlichen litten an mindestens einer psychiatrischen Störung, über 60 % zeigten zwei oder mehr koexistierende Störungsbilder. Mittels Faktorenanalyse wurden für männliche Jugendliche drei klinisch relevante Störungsmuster anhand von psychopathologischen Merkmalen ausgearbeitet: ADHS/Störung des Sozialverhaltens und Drogenmissbrauch; Angst und Depression; Trennungsangst/PTBS und Alkoholmissbrauch. Für weibliche Jugendliche ergaben sich vier Störungsmuster: Trennungsangst/Sozialphobie/Dysthymie; PTBS und Drogenmissbrauch in Kombination mit entweder ADHS oder Störung des Sozialverhaltens; Depression und Alkoholmissbrauch. Schlussfolgerungen: Aufgrund der hohen Raten an Psychopathologien bei inhaftierten Jugendlichen ist eine umfassende und strukturierte Diagnostik unerlässlich für die weitere Behandlungsentscheidung, da bei inhaftierten Jugendlichen verschiedene Störungsmuster berücksichtigt werden müssen. Die gefundenen Störungsmuster könnten im Zusammenhang mit der Entstehung delinquenten Verhaltens, mit unterschiedlichen Behandlungsbedürfnissen und mit dem Risiko für erneute Delikte wichtig sein.

Psychopathology in African unaccompanied refugee minors in Austria

We assessed the prevalence of a range of psychopathology among African unaccompanied refugee minors (URMs) in Austria. Additionally, the predictive value of war exposure on PTSD symptoms was examined. Forty-one URMs were assessed with the Mini-International Neuropsychiatric Interview for children and adolescents, the Youth Self-Report, the UCLA PTSD Reaction Index and Facts About You. As expected, 56% of youth had at least one diagnosis by structured clinical interview. The most common diagnoses were adjustment disorder, PTSD and dysthymia. War affliction marginally predicted (p = 0.065) PTSD controlling for age and gender. URMs had high levels of psychopathology compared to norms. Their PTSD rates were somewhat lower than found in previous studies. We discuss methodological and substantive reasons for this finding. Future studies need to examine URMs across the entire diagnostic spectrum and employ multi-method designs to yield valid results. The psychopathology in URMs has clinical and forensic implications.

An assessment of secondary traumatic stress in juvenile justice education workers

Given the frequency and violent character of the traumas encountered by juvenile offenders, staff members who regularly interact with juveniles in custody are at risk of developing secondary traumatic stress. Juvenile justice teachers and staff (N = 118) were administered a cross-sectional survey, including the Secondary Traumatic Stress Scale. Respondents said the students were moderately traumatized (47%), severely traumatized (27%), and very severely traumatized (7%). Regarding STS, the most frequently reported symptom was intrusive thoughts related to work with the students, mentioned by 61% of respondents. Additionally, 81% met at least one, 55% met two, and 39% met all three core diagnostic criteria for posttraumatic stress disorder. Recommendations for juvenile justice staff members and for the organization are provided to address practice and policy implications.