Epidemiology and treatment of mental health problems in juvenile delinquents

Sex differences in youth with mental health problems in inpatient, outpatient and youth justice settings

BACKGROUND

Approximately 40-70% of justice-involved youth have untreated mental health problems. There is no current research that directly compares the mental health profiles of youth involved in the justice system to that of inpatients and outpatients. The research reported is significant because it directly compares the needs of these population by use of the same suite of standardized assessment tools.

METHODS

The sample consisted of 755 youth aged 16-19 years recruited from youth justice and mental health facilities in Ontario, Canada. Participants completed semi-structured assessment interviews using the interRAI child and youth suite of instruments to assess for internalizing and externalizing concerns as well as exposure to traumatic life events.

RESULTS

Findings indicated that justice-involved youth experienced higher levels of certain types of trauma. Analyses examining sex differences indicated that, controlling for age, males in the youth justice group reported higher cumulative trauma compared to male outpatients but not inpatients. Females in the youth justice group reported experiencing higher cumulative trauma compared to female outpatients and inpatients. In addition, controlling for sex and age, the youth justice group reported lower internalizing symptoms scores than inpatients and outpatients. Finally, males in the youth justice group scored lower than inpatients in externalizing symptoms, whereas females within the youth justice group scored higher in externalizing symptoms compared to inpatients and outpatients.

CONCLUSIONS

Results indicated that youth who are involved with the justice system exhibit significant psychosocial issues that represent complex service needs which require unique interventions in order to be addressed appropriately.

[Mental health among teenage boys remanded to prisoner]

BACKGROUND

Incarceration of young people should be avoided according to Norwegian policy. Even so, young people reside in our prisons at all times. Our aim was to investigate their mental health.

MATERIAL AND METHODS

Among 42 teenage boys (below 20 years of age) remanded to prison, 40 consented to participate in the study. Socio-demographic data were collected and a structured diagnostic instrument (K-SADS) was used to assess their mental health.

RESULTS

Only four participants had no mental disorder. The 36 who had mental disorders had a mean of 2.5 diagnoses. The most common diagnosis was substance abuse/dependence (n = 31). 30 of the adolescents had serious conduct disorders and nine of them fulfilled the ICD-10 criteria for a dissocial personality disorder. Anxiety and/or depressive disorders (n = 14) and hyperkinetic disorders (n = 12) were also frequent. Many of the adolescents had unmet treatment needs in addition to large social problems, such as disrupted education and unemployment. Three of four adolescents had an immigrant background.

INTERPRETATION

Teenage boys remanded to prison have a variety of complex problems. They have an extensive need for psychiatric treatment, drug treatment, education and employment. This calls for multidisciplinary coordinated interventions to avoid further negative development of chronic maladjustment with substance abuse, mental problems and crime.

Social and mental health profiles of young male offenders in detention in Greece

BACKGROUND

Among young offenders, mental health problems have been linked both to more serious delinquent acts and to high recidivism rates, but there has been little study of this in Greece.

AIMS

The aims of this study were to describe demographic and family characteristics of young incarcerated male offenders, to determine the prevalence of mental disorders among them and to compare native Greeks with immigrants on these variables.

METHODS

Ninety-three young males, randomly selected from the three main juvenile detention facilities in Greece, completed the Greek version of the Youth Self Report (YSR); the institutions' social workers completed a questionnaire designed for the study on the youths' demographics and offending.

RESULTS

Results revealed over-representation of immigrants, high levels of psychosocial adversity (large family size, low parental educational level, poverty and family offending history) and high prevalence rates not only of externalizing disorders, such as conduct disorder, but also internalizing disorders, including anxiety, depression and somatizing problems.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Young males in Greek correctional institutions need support at many levels, and especially for mental health problems. This will have implications for staff training and juvenile justice system reform.

Relationships between suicide risk, traumatic experiences, and substance use among juvenile detainees

Youth suicide ideation in juvenile justice settings is a phenomenon with multiple determinants. This article examines relationships among determinants of suicidal ideation utilizing various screening instruments. Consecutive youth admitted to detention in Connecticut (N = 757) completed the Massachusetts Youth Screening Instrument 2 (MAYSI-2), the Suicidal Ideation Questionnaire (SIQ), measures of substance use, and risk and protective factors for violence during intake screening. In bivariate and multivariate analyses (controlling for demographic and MAYSI-2 sub-scale scores), relationships were found between the Traumatic Experiences and Alcohol and Drug Use subscales of the MAYSI-2 and the SIQ. The potential impact of traumatic stress and substance use symptoms in understanding and detecting youths who are at risk for suicide is discussed.

Service Utilization among ethnic minority children with ADHD: a model of help-seeking behavior

Despite a significant increase in the number of children and adolescents who receive clinical services for attention deficit hyperactivity disorder (ADHD), there is still a considerable level of unmet need. Children of ethnic minority status continue to lag well behind their non-minority counterparts in the rate of diagnosis and treatment for the disorder. Racial/ethnic disparities in service use are the result of a combination of access barriers and individual, cultural, and societal factors. The ADHD Help-Seeking Behavior Model is proposed as a framework for understanding factors that may be predictive of service use. Variables specific to ADHD and ethnic-minority populations are integrated within the framework of a four-stage pathway model encompassing problem recognition, decision to seek help, service selection, and service use. The authors argue that by systematically addressing factors related to service use for each ethnic minority group, more effective intervention initiatives can be developed to improve identification and treatment for ADHD among underserved children.

Mental health service provision in juvenile justice facilities: pre- and postrelease psychiatric care

High prevalence rates of mental illness among adolescents in juvenile justice facilities require multifaceted interventions. Children entering justice systems are frequently underserved and having their first contact with psychiatric services. Programming must be multidisciplinary and multifaceted, combining treatment within the facility with postrelease planning. It examines the role of the psychiatrist and the structure of mental health services within juvenile justice facilities.

Anger expression, coping, and substance use in adolescent offenders

The present study examined anger expression and avoidant coping and their relationship to substance use and use-related consequences in a sample of 270 incarcerated adolescents. Outwardly expressed anger was significantly associated with both alcohol and marijuana use and use-related consequences. Avoidant coping was also significantly associated with all outcome variables. There were no significant interactions between anger expression (outward or inward) and avoidant coping. Collectively, results suggest that expression of anger and avoidant coping are independent risk factors for substance use and use-related consequences across two classes of drugs in adolescent offenders.

Racial differences in the mental health needs and service utilization of youth in the juvenile justice system

Mental health placement rates by the juvenile justice system differ by race. However, it is unknown whether mental health needs differ by race. This study attempted to investigate potential differences in mental health needs and service utilization among Caucasian, African American, and Hispanic juvenile justice involved youth. A stratified random sample of 473 youth petitioned, adjudicated, and incarcerated from 1995-1996 was examined using a standard chart review protocol and the Childhood Severity of Psychiatric Illness measure for mental health needs. Significant and unique mental health needs were demonstrated for all racial groups. African American youth demonstrated the greatest level of needs. Minority status indicated significantly lower rates of mental health service utilization. Minority youth in the juvenile justice system are most at risk for underserved mental health needs. Based on the current data, it can be inferred that the first contact with the state's child and adolescent serving system, which includes the juvenile justice and mental health sectors, appears to be through the juvenile justice sector for many minority youth with delinquency problems.

Behavioural and substance use problems in rural and urban delinquent youths

OBJECTIVE

To examine rates of behavioural and substance use problems in incarcerated young offenders and to explore rural and urban differences in the expression and severity of these problems.

METHOD

We assessed a sample of 68 confined male young offenders (63.3% rural and 35.3% urban), using the Drug Use Screening Inventory (DUSI) and the Youth Self-Report (YSR).

RESULTS

Based on clinical cut-offs, data showed high rates of externalizing behavioural problems (75.4%) and substance use problems (95.7%). Urban delinquent youths showed higher rates of attention problems, delinquent behaviours, and externalizing behaviours than those in rural communities.

CONCLUSIONS

Incarcerated young offenders show elevated rates of psychological problems that require treatment. Rural and urban differences in the rates of these problems may reflect differences in community service availability in these areas or in environmental influences on the development of child behavioural problems.

Structured group therapy for posttraumatic stress disorder in incarcerated male juveniles

This is the first study to evaluate the efficacy of a structured group therapy for posttraumatic stress disorder (PTSD) in incarcerated male juveniles. Ten groups of juveniles (n = 45) completed a 12-session intervention with pre- and postassessments composed of the Post Traumatic Stress Disorder Reaction Index (C. Frederick, 1985) and supplementary measures of anxiety, anger, and depression. Overall, group participants experienced significant reductions in self-reported PTSD symptoms. Supplemental analyses suggest that this treatment was most beneficial for youth with trauma related to gang and community violence.

Health issues for adolescents in the justice system

Three major health issues for adolescents in the justice system are discussed: the lack of mental health resources and services for youth in the system, increased prosecution of juveniles as adults (and consequent incarceration of youth in adult jails and prisons), and the epidemic of gun violence in this country. For each issue, the paper describes the scope of the problem, analyzes the components of the problem, and makes recommendations for future research and reform efforts. The analysis and recommendations are based on criminal justice, legal, service integration, and public health research.

Evaluating PTSD in incarcerated male juveniles with the MMPI-A: an exploratory analysis

This is a preliminary study examining the utility of the Minnesota Multiphasic Personality Inventory-Adolescent form (MMPI-A; Butcher, Williams, Graham, Archer, Tellegan, Ben-Porath, & Kaemmer, 1992) for identifying PTSD in incarcerated adolescents. Scores from the MMPI-A were compared with scores and diagnostic criteria from the Post-Traumatic Stress Disorder Reaction Index (PTSD-RI; Frederick, 1985) for a sample of 60 male juvenile delinquents. Results from a MANOVA indicated significant differences in mean scores for MMPI-A Scales 4, 6, and 8 for both PTSD and Non-PTSD groups. The MMPI Supplementary PK scale (Keane, Malloy & Fairbank, 1984), developed for identifying PTSD, was adapted and evaluated for applications with the MMPI-A. Finally, a discriminant function analysis successfully classified juveniles with and without PTSD symptomatology. In summary, the PK scale was moderately successful at identifying post-traumatic stress reactions. Our results suggest that the MMPI-A may serve as a useful screening measure, indicating the need for further evaluation of traumatic experiences in juveniles.

Forensic assessment of juvenile delinquents: prevalence of psychopathology and decision-making at court in the netherlands

Dutch juvenile criminal law, concerning minors between 12 and 18 years old, is marked by its pedagogical character. In cases of serious psychosocial problems or psychiatric disorders, the juvenile court may request a forensic examination in order to be able to impose a measure of restraint. This study was aimed at investigating to what extent the juvenile criminal law achieves the aim enhancing professional help in those cases for which such assistance is indicated. One hundred and eight juveniles who were brought before the court were assessed multidisciplinarily. Sixty-five per cent of the youngsters were qualified for 'definite caseness'. For less than half of them a forensic assessment was ordered by the court. In conclusion, young delinquents should be screened for psychiatric disorders more adequately as soon as they are taken into custody.

Criminal behavior and emotional disorder: comparing youth served by the mental health and juvenile justice systems

This study explored whether youth involved in joint service systems differed from single-agency users in terms of types of crimes committed and clinical functioning. Data from 4,924 youth involved in one county's public mental health and juvenile justice service systems were examined. Twenty percent of those youth receiving mental health services had recent arrest records, and 30% of youth arrested received mental health services. Of all youth arrested in the county, mental health service users had more arrests than non-mental health service users. A subsample of 94 mental health service users with arrests was matched on demographics with 94 mental health service users without arrests. Youth with arrests had a higher frequency of conduct disorder, higher Child Behavior Checklist Externalizing and Total Problem Scale scores, and more functional impairment on the Child and Adolescent Functional Assessment Scale as compared to youth without arrests. Implications for behavioral health service delivery were discussed.

Attitudes toward psychiatric medications among incarcerated female adolescents

OBJECTIVE

Beliefs about and attitudes toward pharmacotherapy have been shown to play an important role in mediating compliance with psychoactive medications. This study is an examination of attitudes toward drug treatment in a sample of delinquent incarcerated girls.

METHOD

Female adolescents (N = 214) in a juvenile detention facility were administered a questionnaire assessing general beliefs and specific concerns about taking psychiatric medications. Demographic and historical data, including prior psychiatric drug treatment and illicit substance abuse, were also examined as possible influencing variables.

RESULTS

Nearly one half of subjects were skeptical about the benefits of pharmacotherapy. Prior illicit drug use did not influence attitudes, but having been treated with psychiatric medication was related to enhanced perceptions of the efficacy and acceptance of such therapy. Specific concerns about untoward effects of pharmacotherapy were identified.

CONCLUSIONS

Results suggest that these delinquent adolescents would benefit from techniques to improve initial attitudes toward treatment and challenge the prescribing physician to consider the unique worries and concerns that may undermine compliance with medication regimens among teenagers.

The nature and characteristics of psychiatric comorbidity in incarcerated adolescents

OBJECTIVES

To determine the prevalence of psychiatric disorders, the degree of psychiatric comorbidity, and the relationship between these and sociodemographic variables in a sample of incarcerated adolescents. A comparison with an age- and sex-matched community sample was conducted.

METHOD

Age- and sex-matched samples of 49 incarcerated adolescents and 49 nondelinquents were compared for psychiatric morbidity and psychosocial characteristics. Psychiatric diagnoses were determined using the Diagnostic Interview for Children and Adolescents-Revised (DICA-R). Additional information on psychosocial, family, and offence characteristics was obtained using a semistructured interview designed specifically for this study. The prevalence of single and comorbid psychiatric disorders was determined.

RESULTS

Approximately 63.3% of incarcerated adolescents had 2 or more psychiatric disorders. The degree of psychiatric morbidity was directly related to indicators of family adversity, physical abuse, other psychosocial variables, or polysubstance abuse. Psychiatric comorbidity was more frequent in females. Incarcerated adolescents were more likely to endorse symptoms of thought disorder.

CONCLUSIONS

Findings identify preventive intervention foci for policy makers and planners in the area of adolescent corrections. Implications for education and training of nonclinical custodial staff are discussed as is the need for a more therapeutic orientation in correctional facilities.

Risk factors for juvenile justice system referral among children in a public mental health system

The objective of this study is to identify, through the use of secondary data, risk factors for juvenile justice system involvement among children entering a public mental health system. Data-sharing agreements between juvenile justice and mental health systems enabled investigators to examine criminal referrals among 645 children between the ages of 10 to 17 who entered community-based public mental health programs in King County, Washington, over the course of a single year. Univariate and logistic regression analyses were performed. Adjusting for age, gender, and ethnicity, children involved in the public mental health system who had juvenile justice referrals were more likely than children involved in the mental health system without juvenile justice referrals to have parents with a history of incarceration, to abuse drugs and/or alcohol, and to have experienced physical abuse. The study shows that some children who receive public mental health services are at particular risk of having an encounter with the juvenile justice system. Understanding the characteristics and experiences of youth who use multiple service systems has important implications for children's mental health services delivery.

Risk of juvenile justice systems referral among children in a public mental health system

This study established the risk of police referral among a cohort of children who were recipients of public mental health services. Investigators used secondary data to calculate the incidence of criminal referral among 645 children, ages 10 to 17, who entered community-based public mental health programs in King County, Washington. Children receiving public mental health services were nearly three times more likely to be referred to the juvenile justice system compared to children of similar age and gender in the general population. Relative risks were particularly high for younger children (10-13 years) and for children of Hispanic, Native American, and Caucasian origin. Understanding the characteristics and experiences of children who use multiple-service systems has important implications for services delivery. In addressing the needs of youth who have both mental illness and criminal involvement, age- and culturally specific interventions and advocacy efforts are warranted.

Screening for drug abuse among adolescents in clinical and correctional settings using the Problem-Oriented Screening Instrument for Teenagers

Recent research has indicated high rates of substance abuse among adolescents with emotional and behavioral disorders. Moreover, adolescents in clinical and correctional settings found to have comorbid disorders involving substance abuse experience higher morbidity and mortality rates when compared to adolescents having one or no condition. The present study examines the ability of the Problem-Oriented Screening Instrument for Teenagers (POSIT) to identify DSM-III-R-defined psychoactive substance use disorders among 342 adolescents aged 12-19 years. Participants were sampled from school, clinical, and correctional settings. Optimal-scale cut scores for drug abuse diagnosis classification were derived by a minimum loss function method that minimized false classifications. When using the optimal cut score of two for the total sample, the standard POSIT substance use/abuse scale obtained a drug abuse diagnosis classification accuracy of 84% with sensitivity and specificity ratios of 95% and 79%, respectively. The internal validity of the standard 17-item substance use/abuse scale was subsequently examined by principle component analysis, item analysis, and coefficient alpha. The internal validity analyses were conducted to determine if a shortened scale could be developed and yet retain acceptable classification accuracy. When using the optimal cut score of two for the total sample, the revised 11-item scale obtained a drug abuse diagnosis classification accuracy of 85% with sensitivity and specificity ratios of 91% and 82%, respectively. The results suggest that the POSIT can serve as a useful first-gate instrument to identify adolescents in need of further drug abuse assessment.