Prescribing Psychotropic Medications for Justice-Involved Juveniles

Psychiatric disorders are exceedingly common in justice-involved youth. Relevant justice systems are varied, evolving, complex, and underserved. The intent of this article is to highlight the research and best practices related to managing the psychiatric disorders of justice-involved youths with a particular focus on pharmacotherapy. We review relevant features of the justice system and related case law, how prescribing for these individuals varies from both community settings and for incarcerated adults, effective assessment and medication selection, informed consent, management of nonadherence and medication diversion, and applied evidence for specific psychiatric problems common in these patients. Psychiatrists caring for justice-involved youth will benefit from tools, like this article, for training and orientation to provide timely and effective treatment services and consultation in these settings.

Juvenile Justice-Involved Youth: Preventive Health Services Received Prior to Detention

Few studies on youth in the juvenile justice system describe preventive services received at community health visits. We determined preventive services received at their most recent visit to a health care provider through a cross-sectional survey of youth at a detention center. Data on their health outcomes were abstracted from medical records. Many did not receive comprehensive screenings for sexual health, mental health symptoms, or substance use at well-child visits in the past year. Health outcomes were not significantly different from those who did not attend a well visit in the past year. Limited preventive screenings could explain why well checks did not influence health outcomes; therefore, providers should incorporate recommended screenings into sick visits as well as preventive visits.

Utilization of substance use treatment among criminal justice-involved individuals in the United States

Over six million individuals are involved with the criminal justice system in the United States, of which a large proportion report extensive substance use. We examined the extent to which criminal justice-involvement affects substance use treatment utilization among participants from one of the largest annual surveys on substance use in the U.S., the National Survey on Drug Use and Health (NSDUH). Multivariable logistic regression analyses indicated that criminal justice involvement was significantly associated with receiving substance use treatment in the past year (AOR 8.00, 95% CI: 6.23-10.27, p < 0.001). However, those with criminal justice histories continue to face barriers to treatment. Among individuals ages 12 and older who reported past year criminal justice involvement and met criteria for a substance use disorder, 18.9% reported receiving past year substance use treatment. After controlling for key demographic and drug use characteristics in a multivariable logistic regression model, Black criminal justice involved Americans were somewhat less likely to report receiving substance use treatment in the past year compared to White criminal justice involved Americans, although the association was not significant (AOR 0.87, 95% CI 0.58-1.29, p = 0.481). Treatment programs targeted to increase minority engagement and address persistent barriers to substance use treatment may be valuable for curbing substance use and recidivism among criminal justice-involved individuals.

Prevalence and correlates of police contact amongst youth with bipolar disorder

OBJECTIVES

While multiple studies have examined prevalence and correlates of police contact in adults with bipolar disorder (BD), literature on this topic in youth is sparse. We therefore examined the prevalence and correlates of police contact amongst youth with BD.

METHODS

The study included 197 youth with BD and 127 healthy controls, ages 14-20 years. Semi-structured interviews were used to determine diagnoses, treatment and police contact. The Life Problems Inventory examined self-reported trait impulsivity and emotional dysregulation. Analyses examined demographic and clinical variables among youth with versus without lifetime police contact. Variables that were associated with police contact at p<0.1 in univariate analyses were evaluated in a logistic regression model. Specific reasons for police contact, determined based on chart review, are reported descriptively.

RESULTS

Lifetime prevalence of police contact was significantly higher amongst youth with BD versus healthy controls (36% versus. 3%; χ ² = 47.58, p =<0.001). In multivariate analyses, age of BD onset, living with both natural parents, comorbid substance use disorder and conduct disorder, and psychiatric hospitalization were associated with police contact. Common reasons for police contact included shoplifting/theft and suicidality/self-harm .

LIMITATIONS

The cross-sectional and retrospective study design precludes conclusions regarding directionality of the observed associations and/or causal inferences.

CONCLUSIONS

One third of youth with BD experienced police contact. Correlates generally aligned with those observed with adults. Future longitudinal research is warranted to understand distal and proximal antecedents of police contact, with the goal of developing strategies to prevent police contact, incarceration, and related consequences.

An Updated Systematic Review and Meta-regression Analysis: Mental Disorders Among Adolescents in Juvenile Detention and Correctional Facilities

OBJECTIVE

To synthesize evidence on the prevalence of mental disorders in adolescents in juvenile detention and correctional facilities and examine sources of heterogeneity between studies.

METHOD

Electronic databases and relevant reference lists were searched to identify surveys published from January 1966 to October 2019 that reported on the prevalence of mental disorders in unselected populations of detained adolescents. Data on the prevalence of a range of mental disorders (psychotic illnesses, major depression, attention-deficit/hyperactivity disorder [ADHD], conduct disorder, and posttraumatic stress disorder [PTSD]) along with predetermined study characteristics were extracted from the eligible studies. Analyses were reported separately for male and female adolescents, and findings were synthesized using random-effects models. Potential sources of heterogeneity were examined by meta-regression and subgroup analyses.

RESULTS

Forty-seven studies from 19 countries comprising 28,033 male and 4,754 female adolescents were identified. The mean age of adolescents assessed was 16 years (range, 10-19 years). In male adolescents, 2.7% (95% CI 2.0%-3.4%) had a diagnosis of psychotic illness; 10.1% (95% CI 8.1%-12.2%) major depression; 17.3% (95% CI 13.9%-20.7%) ADHD; 61.7% (95% CI 55.4%-67.9%) conduct disorder; and 8.6% (95% CI 6.4%-10.7%) PTSD. In female adolescents, 2.9% (95% CI 2.4%-3.5%) had a psychotic illness; 25.8% (95% CI 20.3%-31.3%) major depression; 17.5% (95% CI 12.1%-22.9%) ADHD; 59.0% (95% CI 44.9%-73.1%) conduct disorder; and 18.2% (95% CI 13.1%-23.2%) PTSD. Meta-regression found higher prevalences of ADHD and conduct disorder in investigations published after 2006. Female adolescents had higher prevalences of major depression and PTSD than male adolescents.

CONCLUSION

Consideration should be given to reviewing whether health care services in juvenile detention can address these levels of psychiatric morbidity.

Advocacy and Collaborative Health Care for Justice-Involved Youth

Children and adolescents who become involved with the justice system often do so with complex medical, mental health, developmental, social, and legal needs. Most have been exposed to childhood trauma or adversity, which both contribute to their involvement with the justice system and negatively impact their health and well-being. Whether youth are held in confinement or in their home communities, pediatricians play a critical role in promoting the health and well-being of justice-involved youth. Having a working knowledge of the juvenile justice system and common issues facing justice-involved youth may help pediatricians enhance their clinical care and advocacy efforts. This policy statement is a revision of the 2011 policy "Health Care for Youth in the Juvenile Justice System." It provides an overview of the juvenile justice system, describes racial bias and overrepresentation of youth of color in the justice system, reviews the health and mental health status of justice-involved youth, and identifies advocacy opportunities for juvenile justice reform.

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.

Affective Factors That Contribute to the Quality of Life of Juvenile Inmates with Attention-Deficit/Hyperactivity Disorder: A Focus on Items from the Korean Youth Self Report

OBJECTIVES

This study investigated quality of life in Korean juvenile inmates with attention-deficit/hyperactivity disorder (ADHD) and the impact of behavioral and emotional problems on quality of life.

METHODS

In total, 200 inmates were evaluated using the Korean version of the Mini-International Neuropsychiatric Interview (K-MINI) and the Korean version of the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime (K-SADS-PL-K). We extracted the inmates with ADHD and evaluated their quality of life, behavioral problems, and emotional problems with the Pediatric Quality of Life Inventory (PedsQL) and the Korean Youth Self Report (K-YSR) scale. Descriptive statistics, Pearson correlation analysis, and multiple regression analysis were conducted.

RESULTS

Among the 200 total inmates, 68 were diagnosed with ADHD by the K-SADS-PL-K. Most of the correlations between PedsQL scores and K-YSR items were significant. Multiple regression analysis showed that PedsQL could be predicted by affective problems (among the DSM-oriented scales of the K-YSR) and attention problems (among the syndrome scales of the K-YSR).

CONCLUSION

Our results demonstrate that, among juvenile inmates with ADHD, quality of life was negatively correlated with most behavioral and emotional problems. Meanwhile, the significant influence of affective and attention problems on inmates' quality of life suggests the necessity of comprehensive treatments for this group.

Prospective Risk and Protective Factors for Juvenile Arrest Among Youth At Risk for Maltreatment

This study aimed to prospectively identify ecological risk factors for juvenile arrest in a sample of youth at risk for maltreatment. Chi-Squared Automatic Interaction Detector analysis was performed with data from 592 youth from the Longitudinal Studies of Child Abuse and Neglect to identify the optimal combination of age 14 predictors of past-year arrest at age 16. Results extended previous research, which has identified being male, having more conduct disorder symptoms, suspension from school, perceived school importance, witnessing family violence, and having a jailed family member as key risk and protective factors for arrest by identifying important interactions among these risk factors. These interactions differentiate youth at the greatest risk of arrest, which, in this sample, were males with greater than two symptoms of conduct disorder who witnessed family violence. These findings suggest that longitudinal and multi-informant data could inform the refinement of actuarial risk assessments for juvenile arrest.

Factors associated with knowledge of where to access health care among youth in juvenile detention: a mixed methods study

BACKGROUND

Mental illness, substance use, and sexual health issues are major health concerns among detained youth compared with the general population. There is a dearth of studies that demonstrate what detained youth in the United States know about where to access health services in the community. Given the magnitude of these health concerns among detained youth compared with youth in the general population, knowing where to access health care in the community could lead to early intervention and better health outcomes.

OBJECTIVES

This study determines what detained youth know about where to access care for mental health symptoms, substance use, and sexually transmitted infections, and identifies the factors associated with knowledge of where to access health care.

METHODS

Data were collected using mixed methods from a cross-sectional sample of 301 detained youth. Information was obtained using surveys (which included closed and open-ended questions), and data abstraction from their medical records. Logistic regression analysis, Chi-squared tests and thematic analysis were used to analyze the data. Results Having a primary care provider, perceived susceptibility, and previous experiences with health care providers all influenced what youth in our study knew about where to seek health care.

CONCLUSIONS

The use of mixed methods including open-ended questions allowed us to gain a better perspective of where detained youth would seek help for health issues. Detained youth have poorer health outcomes yet many did not know where to access health resources. Primary care providers who see youth should provide comprehensive, youth-friendly services.

Psychische Störungen und kriminelle Rückfälle bei männlichen jugendlichen Gefängnisinsassen

Zusammenfassung. Fragestellung: Die Prävalenz psychischer Störungen unter inhaftierten Jugendlichen ist hoch. Offen ist die Frage, ob damit eine erhöhte kriminelle Rückfälligkeit einhergeht. Methodik: Zwischen dem 01.08.2010 und 31.10.2012 wurden im kantonalen Jugendgefängnis Zürich alle inhaftierten männlichen Jugendlichen bei Eintritt psychiatrisch untersucht (N = 122). Die psychischen Störungen wurden anhand eines standardisierten Interviews erfasst. Nach der Haftentlassung wurden die Probanden im Kantonalen Rechtsinformationssystem betreffend Rückfälligkeit während eines Jahres nachkontrolliert. Ergebnisse: 90.2 % der Insassen litten unter mindestens einer psychiatrischen Störung. Über 70 % der Jugendlichen waren zum Zeitpunkt ihrer Inhaftierung von mehreren psychiatrischen Erkrankungen betroffen. Es konnten vier voneinander unabhängige Störungskategorien unterschieden werden: affektive Störungen, Angststörungen, Verhaltensstörungen und Abhängigkeitserkrankungen. Betreffend Rückfälligkeit fand sich, dass Jugendliche mit Verhaltensstörungen und/oder einer Abhängigkeitserkrankung häufiger mit einer Gewaltstraftat rückfällig wurden als aus dem Gefängnis entlassene Jugendliche ohne psychische Erkrankungen. Zudem zeigte sich, dass je jünger die inhaftierten Jugendlichen waren, desto kürzer war die Zeit nach ihrer Entlassung, bis sie eine Gewaltstraftat verübten. Schlussfolgerungen: Aufgrund der hohen Prävalenz von psychischen Störungen unter inhaftierten Jugendlichen ist es notwendig, dass diese Minderjährigen auch jugendpsychiatrisch-psychologisch untersucht und adäquat behandelt werden. Neben der psychiatrischen Versorgung der minderjährigen Gefängnisinsassen kann so auch den Anforderungen eines effektiven Opferschutzes und dem Sicherheitsbedürfnis unserer Gesellschaft entsprochen werden.

[Socio-demographic and clinical characteristics of adolescents hospitalized in French units for inmates: Results of a cross-sectional study]

BACKGROUND

In France, on the first of January 2018, 772 underage persons were in jail or about 1.1 % of the incarcerated population. The prevalence of psychiatric disorders among those inmates is high. As a result psychiatric care (and particularly full-time hospitalization) is essential for this population. The unités hospitalières spécialement aménagées (UHSA) are full-time inpatient hospitalization units for inmates in France. Adults but also underage inmates can be admitted to UHSA for voluntary or involuntary hospitalization. However, no study about the characteristics of young patients admitted to UHSA is currently available. The aim of this study is to describe the population of children and adolescent patients hospitalized in these facilities and to evaluate the care provided.

METHOD

We conducted a retrospective study, including all the patients under 18 years of age, who have been hospitalized in UHSA since its creation in 2010 until 31 December 2016. Anonymized data concerning socio-demographic profile, clinical symptoms and care provided have been collected from the medical records of each patient.

RESULTS

Overall 80 underage patients were included, for 120 hospitalisations in UHSA. Those patients are mainly male (80%) with a mean age of 16.7 years. They are mostly hospitalized with their consent (59%) for stays of about 50 days and frequently after self-harm behaviours. The main diagnoses are anxiety disorders (26%) and psychotic disorders (25%). At the end, 86% of the patients are prescribed a psychotropic drug treatment and 40% of those medical drugs are prescribed outside the guidelines. Finally, several specific problems were identified. Especially, contact with families and educators or access to education programs are very challenging.

CONCLUSION

This study highlights the current difficulties encountered in the management of inmate underage patients in full-time psychiatric hospitalization. In this paper, we propose areas for improvement through (1) specific arrangements to receive young patients (specific service's management in order to reinforce the observation of those young people, to facilitate contact with their families, to improve the access to education programs, etc.); (2) specific arrangements in the treatment offered to young patients in UHSA (specific training course for nurses, specific therapeutic programs, etc.); (3) the development of networks working with psychiatric services inside and outside the prison, educators, families and prison services, in order to promote the continuity of cares.

Childhood Maltreatment and Symptoms of PTSD and Depression Among Delinquent Adolescents in Malaysia

Adolescents in the juvenile justice system are known to suffer from various psychological disorders. Less is known about how childhood psychological trauma is related to psychological disorders among delinquent adolescents in Malaysia. This study investigated the relationship between childhood maltreatment and depressive and Posttraumatic Stress Disorder (PTSD) symptoms. Of 327 adolescents 96% were exposed to at least one childhood victimization. Significant differences were found for all types of victimization (i.e. maltreatment, sexual abuse, severe assault, neglect, and family victimization) between delinquent and non-delinquent adolescents. Females were more likely to be involved in family victimization, while males were more likely to experience severe assault and crime victimization. Delinquent adolescents reported depressive and PTSD symptoms significantly more than non-delinquent adolescents. The prevalence of PTSD and depressive symptoms among delinquents was 20.8 and 52.7% respectively. Highly victimized delinquent adolescents and/or those victimized in family-related events were at significantly higher risk to develop psychiatric symptoms.

A model for rigorously applying the Exploration, Preparation, Implementation, Sustainment (EPIS) framework in the design and measurement of a large scale collaborative multi-site study

BACKGROUND

This paper describes the means by which a United States National Institute on Drug Abuse (NIDA)-funded cooperative, Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS), utilized an established implementation science framework in conducting a multi-site, multi-research center implementation intervention initiative. The initiative aimed to bolster the ability of juvenile justice agencies to address unmet client needs related to substance use while enhancing inter-organizational relationships between juvenile justice and local behavioral health partners.

METHODS

The EPIS (Exploration, Preparation, Implementation, Sustainment) framework was selected and utilized as the guiding model from inception through project completion; including the mapping of implementation strategies to EPIS stages, articulation of research questions, and selection, content, and timing of measurement protocols. Among other key developments, the project led to a reconceptualization of its governing implementation science framework into cyclical form as the EPIS Wheel. The EPIS Wheel is more consistent with rapid-cycle testing principles and permits researchers to track both progressive and recursive movement through EPIS. Moreover, because this randomized controlled trial was predicated on a bundled strategy method, JJ-TRIALS was designed to rigorously test progress through the EPIS stages as promoted by facilitation of data-driven decision making principles. The project extended EPIS by (1) elucidating the role and nature of recursive activity in promoting change (yielding the circular EPIS Wheel), (2) by expanding the applicability of the EPIS framework beyond a single evidence-based practice (EBP) to address varying process improvement efforts (representing varying EBPs), and (3) by disentangling outcome measures of progression through EPIS stages from the a priori established study timeline.

DISCUSSION

The utilization of EPIS in JJ-TRIALS provides a model for practical and applied use of implementation frameworks in real-world settings that span outer service system and inner organizational contexts in improving care for vulnerable populations.

TRIAL REGISTRATION

NCT02672150 . Retrospectively registered on 22 January 2016.

Comorbidities and correlates of conduct disorder among male juvenile detainees in South Korea

BACKGROUND

The purpose of this study was to examine the rate and distribution of comorbidities, severity of childhood maltreatment, and clinical characteristics of adolescents with conduct disorder detained in a juvenile detention center in South Korea.

METHODS

In total, 173 juvenile detainees were recruited. We analyzed the distribution of psychiatric disorders among the sample and compared the rate of comorbidities between groups with and without conduct disorder. We compared the two groups in terms of demographic and clinical characteristics, as well as severity of childhood maltreatment and psychiatric problems, using the Young Self Report (YSR) scale.

RESULTS

A total of 95 (55%) of the detainees were diagnosed with conduct disorder, and 93 (96.9%) of them had at least one comorbid axis I psychiatric disorder. Detainees with conduct disorder had a higher number of comorbid psychiatric disorders; a higher rate of violent crime perpetration; had suffered more physical, emotional, and sexual abuse; and showed higher total YSR scores and externalizing behavior, somatic complaints, rule-breaking behavior, and aggressive behavior YSR subscale scores.

CONCLUSIONS

Conduct disorder is a common psychiatric disorder among juvenile detainees in South Korea, who tend to commit more violent crimes and show more psychopathology than detainees who do not have conduct disorder. These findings highlight the importance of diagnosing and intervening in conduct disorder within the juvenile detention system.

Trajectories of Substance Use Disorder in Youth After Detention: A 12-Year Longitudinal Study

OBJECTIVE

To identify trajectories of substance use disorders (SUDs) in youth during the 12 years after detention and how gender, race/ethnicity, and age at baseline predict trajectories.

METHOD

As part of the Northwestern Juvenile Project, a longitudinal study of 1,829 youth randomly sampled from detention in Chicago, Illinois from 1995 through 1998, participants were reinterviewed in the community or correctional facilities up to 9 times over 12 years. Independent interviewers assessed SUDs using the Diagnostic Interview Schedule for Children 2.3 (baseline) and the Diagnostic Interview Schedule IV (follow-ups). Primary outcome was a mutually exclusive 5-category typology of disorder: no SUD, alcohol alone, marijuana alone, comorbid alcohol and marijuana, or "other" illicit ("hard") drug. Trajectories were estimated using growth mixture models with a 3-category ordinal variable derived from the typology.

RESULTS

During the 12-year follow-up, 19.6% of youth did not have an SUD. The remaining 81.4% were in 3 trajectory classes. Class 1 (24.5%), a bell-shaped trajectory, peaked 5 years after baseline when 42.7% had an SUD and 12.5% had comorbid or "other" illicit drug disorders. Class 2 (41.3%) had a higher prevalence of SUD at baseline, 73.8%. Although prevalence decreased over time, 23.5% had an SUD 12 years later. Class 3 (14.6%), the most serious and persistent trajectory, had the highest prevalence of comorbid or "other" illicit drug disorders-52.1% at baseline and 17.4% 12 years later. Males, Hispanics, non-Hispanic whites, and youth who were older at baseline (detention) had the worst outcomes.

CONCLUSION

Gender, race/ethnicity, and age at detention predict trajectories of SUDs in delinquent youth. Findings provide an empirical basis for child psychiatry to address health disparities and improve prevention.

Prevalence of psychiatric disorders, comorbidity patterns, and repeat offending among male juvenile detainees in South Korea: a cross-sectional study

BACKGROUND

High rates of psychiatric disorders and comorbidities have been reported in juvenile detainees, and both phenomena are thought to contribute to repeat offending. However, research on this topic has been limited in Asian countries, like South Korea. The purpose of this study was to examine the prevalence of psychiatric disorders, comorbidity patterns, and the relationship between psychiatric disorders and repeat offending among a cross-section of youths detained in a male juvenile detention center in South Korea.

METHODS

One hundred seventy-three juvenile detainees were recruited. The distribution of psychiatric disorders within the sample was estimated by applying criteria from the Diagnostic and Statistical Manual of Mental Disorders IV. Logistic regression was used to assess significant comorbidity patterns and relationships between psychiatric disorders and repeat offending.

RESULTS

In all, 90.8% of the detainees had at least one psychiatric diagnosis, and 75.1% had psychiatric comorbidities. The most common psychiatric disorder was alcohol use disorder, followed by conduct disorder and attention-deficit hyperactivity disorder. Among the comorbidities present, alcohol use disorder with disruptive behavior disorder was the most common combination. The presence of two psychiatric disorders was associated with a higher rate of recidivism, and alcohol use disorder was also associated with repeat offending when combined with disruptive behavior disorders, but not with anxiety disorders, major depression, or psychotic disorders.

CONCLUSIONS

Juvenile detainees evidence high rates of psychiatric disorders and comorbidities. Assessment of and intervention in psychiatric disorders, especially alcohol use disorder and comorbid alcohol use disorder with disruptive behavior disorders, may help prevent further offenses.

Understanding the Influence of Mental Health Diagnosis and Gender on Placement Decisions for Justice-Involved Youth

Justice-involved youth have high rates of psychiatric diagnoses, and these youth are often placed out-of-home, although evidence identifies several negative implications of juvenile confinement, especially for youth with psychopathology. Furthermore, youth in the justice system may be processed differently based on gender. As males and females tend to manifest symptoms differently, the psychopathology of youth may act to moderate the relationship between gender and placement in the juvenile justice system. The present study used a large, diverse sample (n = 9 851, 19.8 % female) to examine whether youth placed in various types of out-of-home facilities differed in terms of externalizing, internalizing, substance use, or comorbid disorders, and to determine the predictive value of mental health diagnoses in placement decisions. The moderation effect of psychopathology and substance use on the relationship between gender and placement also was explored. The results indicated that each type of disorder differed across placements, with internalizing being most prevalent in non-secure, and externalizing, comorbid, and substance use being most prevalent in secure settings. Mental health diagnoses improved the prediction of placement in each out-of-home placement beyond legal and demographic factors such that externalizing and substance use disorders decreased the likelihood of placement in non-secure settings, and internalizing, externalizing, and substance use disorders increased the likelihood of placement in secure and state-secure facilities. The relationship between internalizing pathology and placement in more secure facilities was moderated by externalizing pathology. The relationship between gender and placement was significantly moderated by mental health such that females with mental health diagnoses receive less secure placements. Implications for policymakers and practitioners are discussed, as well as implications for reforming juvenile justice within a developmental approach.

Health Disparities in Drug- and Alcohol-Use Disorders: A 12-Year Longitudinal Study of Youths After Detention

OBJECTIVES

To examine sex and racial/ethnic differences in the prevalence of 9 substance-use disorders (SUDs)--alcohol, marijuana, cocaine, hallucinogen or PCP, opiate, amphetamine, inhalant, sedative, and unspecified drug--in youths during the 12 years after detention.

METHODS

We used data from the Northwestern Juvenile Project, a prospective longitudinal study of 1829 youths randomly sampled from detention in Chicago, Illinois, starting in 1995 and reinterviewed up to 9 times in the community or correctional facilities through 2011. Independent interviewers assessed SUDs with Diagnostic Interview Schedule for Children 2.3 (baseline) and Diagnostic Interview Schedule version IV (follow-ups).

RESULTS

By median age 28 years, 91.3% of males and 78.5% of females had ever had an SUD. At most follow-ups, males had greater odds of alcohol- and marijuana-use disorders. Drug-use disorders were most prevalent among non-Hispanic Whites, followed by Hispanics, then African Americans (e.g., compared with African Americans, non-Hispanic Whites had 32.1 times the odds of cocaine-use disorder [95% confidence interval = 13.8, 74.7]).

CONCLUSIONS

After detention, SUDs differed markedly by sex, race/ethnicity, and substance abused, and, contrary to stereotypes, did not disproportionately affect African Americans. Services to treat substance abuse--during incarceration and after release--would reach many people in need, and address health disparities in a highly vulnerable population.

Prevalence of psychiatric disorders among juvenile offenders in Malaysian prisons and association with socio-demographic and personal factors

PURPOSE

The number of juvenile offenders admitted to Malaysian prisons is alarming. The purpose of this paper is to determine the presence of any psychiatric disorders and their association with personal characteristics of juvenile detainees in prisons across Peninsular Malaysia.

DESIGN/METHODOLOGY/APPROACH

Detainees were recruited from five different prisons in Peninsular Malaysia and interviewed by a psychiatrist using the MINI-Kid and FACES-IV, relevant personal and family information was also collected.

FINDINGS

A total of 105 detainees participated in the study. Almost all of the offenders (93.3 per cent) had at least one diagnosable psychiatric disorder and more than half (76.2 per cent) had two or more psychiatric diagnoses. Conduct disorder (CD) was the commonest disorder (59.0 per cent), while substance use disorders (SUD) was the commonest co-morbidity. A significant correlation was found between presence of CD, education level and SUD. Almost all (61/62, 98.4 per cent) of the detainees with CD, had not completed schooling (OR 8.03, 95 per cent CI 1.01-71.35), and detainees with this disorder were more likely to use substances than detainees without CD (OR 4.35, 95 per cent CI 1.90-9.99). Detainees with any psychiatric diagnosis were more likely to have four or more siblings in their families (OR 5.5, 95 per cent CI 1.1-26.9).

ORIGINALITY/VALUE

There is a high prevalence of psychiatric disorders among juvenile offenders in Malaysian prisons, detection and intervention would be important.

Cortical Volume Alterations in Conduct Disordered Adolescents with and without Bipolar Disorder

Background: There is increasing evidence that bipolar disorder (BD) and conduct disorder (CD) are co-occurring disorders. Magnetic resonance imaging has revealed differences in the structure and function of the frontal cortex in these disorders when studied separately; however, the impact of BD comorbidity on brain structure in adolescents with CD has not yet been examined. Method: We conducted an optimized voxel based morphometry (VBM) study of juvenile offenders with the following diagnoses: conduct disorder with comorbid bipolar disorder (CD-BD; n = 24), conduct disorder without bipolar disorder (CD; n = 24) and healthy controls (HC, n = 24). Participants were 13–17 years of age, in a residential treatment facility for repeat offenders. The three groups in this study were similar in age, gender, socioeconomic status and ethnicity. Results: We found CD-BD subjects had decreased volume relative to controls at the voxel level in the right medial prefrontal cortex (PFC). Using a Threshold-Free Cluster Enhancement (TFCE) technique, the CD-BD subjects had significantly decreased volumes of the right medial prefrontal cortex and portions of the superior and inferior frontal gyrus, anterior cingulate and temporal gyrus. The CD subjects did not have differences in brain volume compared to control subjects or CD-BD subjects. Conclusions: Our findings suggest the comorbidity between CD and BD is associated with neurobiological impact namely volumetric differences from healthy controls. Furthermore subjects with this comorbidity had poorer lifetime functioning, more mood and attentional dysfunction, and more medication exposure than subjects with CD who were not BD.

Prevalence of ADHD in a sample of Italian students: a population-based study

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common diagnosis for children and adolescents, although the reported estimates for prevalence are extremely variable worldwide. In the present work we investigate the prevalence of ADHD in a sample of Italian students in a study divided in two phases. In Phase I, a total of 6183 schoolchildren (3178 males and 3005 females, aged range 5-15 years) were screened using the SDAI rating scale for teachers. In Phase II, the parents of children and adolescents who met high screen criteria according to SDAI (cut-off>14; n=471, 7.3%) were invited to complete a specific clinical-diagnostic assessment for ADHD with the help of an experienced clinician. Within the entire sample, 107 children dropped out and 12 had mental retardation, whereas 332 subjects (278 males and 54 females, age range 5-14 years) completed the Phase II of the study. One hundred ninety subjects (163 males and 27 females, male: female ratio 6:1, mean age 8 years) were diagnosed with ADHD, indicating a prevalence of 3%. ADHD subtypes included the following: combined (n=108; 56.8%), inattentive (n=48; 25.2%) and hyperactive/impulsive (n=33; 17.3%). Our findings are in line with other reports of ADHD prevalence in the European Countries, and may contribute to underline the impact of this phenomenon in the population, and the need of achieving an improvement in the quality of the public health mental service for the prevention and treatment of ADHD.