Suicidal Ideation and Behavior in Youth in the Juvenile Justice System: A Review of the Literature

Suicide Prevention Takes a Nation: Collaborative Approaches to Universalize Suicide Prevention

Suicide is a complex public health issue impacting many children and adolescents-and their families-each year, and it requires a complex public health solution. Local, state, and national collaboratives that leverage evidence-based strategies, foster community engagement, and prioritize equity are necessary to holistically address this issue. Here, the authors discuss the necessary steps for fostering inclusive community partnerships and outline the rationale for partnering with schools, youth groups, faith organizations, parent-teacher organizations, clinical settings, and professional organizations, as well as collaborating with the juvenile justice and child welfare systems and working together to foster suicide prevention policy.

Community and household-level incarceration and its association with mental health in a racially/ethnically diverse sample of families

This study examines the association between community incarceration rates, household incarceration, and the mental health of parents and children. Participant families had children ages 5-9 (n = 1307) from the African American, Latinx, Hmong, Somali/Ethiopian, Native American, and White communities in the Twin Cities, Minnesota. Linear mixed models were used to estimate associations between parent and child mental health, household incarceration exposure, and census tract race, ethnicity and gender-specific incarceration rates matched to the family's home address and race/ethnicity. Findings indicated that living in census tracts with elevated incarceration rates of men from your same racial or ethnic group was significantly associated with psychological distress in parents and externalizing behaviors in boys, regardless of household exposure to incarceration. The association between incarceration rates and externalizing behaviors was only observed among girls with exposure to household incarceration. Policies that deconstruct pervasive racism in penal systems are needed to improve population mental health.

Suicidality and Non-Suicidal Self-Injury: A Narrative Review of Measurement, Risk, and Disparities among Minoritized and System-Involved Youth in the USA

Suicidality and non-suicidal self-injury (NSSI) among youth in the United States continue to be a growing and serious public health concern. With alarming rates of suicide trending in the wrong direction, researchers are committed to bending the curve of suicide and reducing rates by 2025. Understanding the antecedents and conditions, existing measures, and disparate prevalence rates across minoritized groups is imperative for developing effective strategies for meeting this goal. This study presents a narrative review of the operationalization, measurement, risk factors (e.g., firearms and social media), and disparities across race, ethnicity, age, gender identity, ability, sexual orientation, immigration statuses, and system involvement (e.g., foster care and juvenile justice) of suicidality and non-suicidal self-harm across youth in the United States. Implications for research, practice, and policy approaches that incorporate positive youth development, cultural, and youth participation in interventions are discussed.

Anger as a Correlate of and Longitudinal Risk Factor for Suicidal Ideation in Adolescents

Suicide a leading cause of death among adolescents and is nearly always preceded by suicidal ideation (SI). Concerningly, SI during adolescence is not uncommon, as it is reported by as much as 20% of American youth. As such, SI in adolescence has been the subject of substantial research. Literature points to anger in adolescence as a relatively strong correlate of SI. However, work is limited, focusing on cross-sectional associations between anger in adolescence and SI and conceptualizing anger as a broad construct, failing to investigate the many narrow facets that comprise it. We address these gaps by investigating anger in adolescence as a (1) cross-sectional and (2) prospective correlate of SI and (3) investigating broad versus narrow conceptualizations of anger in adolescence as they relate to SI. Among two samples (Study 1, nationally representative community-based youth, n = 1,729; Study 2, high-risk juvenile justice involved youth, n = 1,406), anger in adolescence was cross-sectionally related to SI. However, when controlling for SI at baseline, anger in adolescence was not a prospective risk factor for SI at follow-up, nine years later. Finally, narrow facets of anger (e.g., argumentative, defiant, irritable, resentful, spiteful) were not more closely related than broad conceptualizations of anger to SI. These findings indicate that while anger in adolescence is cross-sectionally associated with SI, it should not necessarily be viewed as a valid risk factor for development of SI over the course of nearly a decade. Further, findings did not elucidate any narrow facets of anger that are particularly linked with SI.

Suicide and Suicide Risk in Adolescents

Suicide is the second leading cause of death for 10- to 24-year-olds in the United States and is a global public health issue, with a recent declaration of a National State of Emergency in Children's Mental Health by the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children's Hospital Association. This clinical report is an update to the previous American Academy of Pediatrics clinical report, "Suicide and Suicide Attempts in Adolescents." Because pediatricians and pediatric health care providers are at the front line of care for adolescents amid a child and adolescent mental health crisis, and because of the chronic and severe shortage of mental health specialists, it is important that pediatric health care providers become facile with recognizing risk factors associated with suicidality and at-risk populations, screening and further assessment of suicidality as indicated, and evidence-based interventions for patients with suicidal ideation and associated behaviors. Suicide risk can be mitigated by appropriate screening, bolstering of protective factors, indicated treatment, community resources, and referrals to mental health providers when available.

Examining Individual and Service Delivery Context Variables and Their Association with the Effectiveness of QPR Suicide Prevention Gatekeeper Training

Suicide prevention training programs have spread rapidly within child and public-serving organizations, due to the alarming increase in youth suicide rates. Yet, within these organizations, roles and responsibilities can shape attitudes and intentions related to suicide prevention, thereby influencing the uptake of prevention efforts. As such, various organizational and individual factors can predict uptake, adoption, and maintenance of prevention efforts (Fixsen et al., 2005). To date, few studies have examined the service delivery context in understanding training effectiveness, especially as it relates to QPR (Question Persuade and Refer), one of the most widely disseminated suicide prevention gatekeeper programs. The purpose of this longitudinal study was to evaluate whether individual and organizational characteristics influenced the effectiveness and sustainability of training outcomes, and whether such differences existed among diverse child and public-serving delivery sectors. Several training outcomes that align with the Theory of Planned Behavior (Ajzen, 1991) were examined, including confidence, attitudes, social norms, and suicide prevention behaviors. Measures were assessed prior to and 90 days after the QPR program among a sample of 858 professionals. Community support personnel uniquely showed improvements on social norms while juvenile justice and child welfare workers engaged in more suicide prevention behaviors post training. While trainees across sectors had improved suicide prevention attitudes, law enforcement personnel were the exception. Organizational climate predicted change in suicide prevention attitudes, confidence, and social norms. Trainees who were older, Latinx, and Black had the most improvement on several training outcome variables, but these findings also varied within service sectors.

Non-suicidal Self-Injury, Suicidal Behaviors, and Mental Health Symptoms among Sexual Minority Youth with Juvenile Justice System Involvement

Sexual minority youth have long remained an understudied population within the juvenile justice system, despite emerging evidence suggesting that sexual minority youth are overrepresented. Recent literature indicates that system-involved sexual minority youth may have more behavioral health concerns than their heterosexual counterparts. Even so, more work is needed to elucidate the unique needs of sexual minority youth who become involved in the system, especially as it pertains to suicidal behaviors and non-suicidal self-injury (NSSI). The present study provided a descriptive evaluation of the prevalence of sexual minority youth making early system contact and their mental health concerns. Of the 218 justice-involved youth from a Northeastern family court in the sample, over a quarter identified as a sexual minority (n = 58). Our findings indicated that these youth evidenced significantly higher scores on a mental health screener compared to their heterosexual counterparts, evidencing greater symptomology on scales indicative of depression/anxiety, thought disturbance, etc. Further, sexual minority youth reported higher rates of lifetime, past year, and past month NSSI as well as lifetime and past year suicide attempts. These findings highlight the need to support the well-being of sexual minority youth in the juvenile justice system by screening for and addressing their mental health needs in this unique setting.

Applying Item Response Theory Analysis to the SAVRY in Justice-Involved Youth

This study investigated item- and test-level functioning of the Structured Assessment of Violence Risk in Youth (SAVRY) and differential item functioning (DIF) across gender and race/ethnicity in justice-involved youth (JIY) using item response theory analysis. Participants were 868 JIY (23.7% female; 26.9% White, 50.9% Black, and 22.2% Hispanic) in pre-trial detention centers in Connecticut. Results obtained from the application of the graded response model showed that the SAVRY items were not equally discriminating JIY with varying levels of the latent trait, with "Poor compliance" as the most discriminating item and "History of self-harm or suicide attempts" as the least discriminating item. At the test level, the SAVRY provided precise (reliable) information about the latent trait for the majority of JIY whose latent trait between two standard deviations below and above the mean. Results of DIF revealed that six items operated inconsistently between White, Black, and Hispanic JIY, among which two items also functioned differentially across gender.

E-Connect: Linking probation youth at risk for suicide to behavioral health services

OBJECTIVE

Youth involved in the justice system (YIJ) have higher rates of suicidal thoughts and behaviors (STB) and associated behavioral health (BH) problems, yet lower levels of service use compared to youth in the general population. This study examined the efficacy of e-Connect, a digital clinical decision support system (CDSS), at improving STB risk identification, referral, and linkage to BH services by probation officers. As the intervention spanned pre- and post-COVID-19 shutdown periods, we also examined the disruption in public agencies' service provision on study outcomes.

METHOD

Administrative record data (1,488 youth, ages 10-18 years, 56% male, 56% White) allowed examination of differences between care-as-usual (baseline) and e-Connect in screening, identification of STB and BH problems, referral, and treatment initiation.

RESULTS

Compared to care-as-usual, probation officers using e-Connect were over five times as likely to identify YIJ with STB (adjusted odds ratio [aOR] = 5.86; 95% confidence interval, CI [3.24, 11.7]) and over 11 times more likely to refer YIJ in need of BH services to treatment (aOR = 11.04; 95% CI [6.54, 19.43]). In turn, youth referred to treatment via e-Connect were nearly 17 times more likely to initiate (aOR = 16.92; 95% CI [9.17, 32.60]). Results remained unchanged during the pre- and post-COVID-19 shutdown periods.

CONCLUSION

e-Connect is one of the first digital STB screening, referral, and linkage-to-service systems that use CDSS technology to successfully assist probation officers in linking youth on their caseload to treatment. Such an approach may support identification of STB and cross-systems linkage in other youth-serving organizations, such as schools, that increasingly manage youth BH problems with minimal clinical support. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Adult criminal outcomes of juvenile justice involvement

BACKGROUND

The juvenile justice system in the USA adjudicates over seven hundred thousand youth in the USA annually with significant behavioral offenses. This study aimed to test the effect of juvenile justice involvement on adult criminal outcomes.

METHODS

Analyses were based on a prospective, population-based study of 1420 children followed up to eight times during childhood (ages 9-16; 6674 observations) about juvenile justice involvement in the late 1990 and early 2000s. Participants were followed up years later to assess adult criminality, using self-report and official records. A propensity score (i.e. inverse probability) weighting approach was used that approximated an experimental design by balancing potentially confounding characteristics between children with v. without juvenile justice involvement.

RESULTS

Between-groups differences on variables that elicit a juvenile justice referral (e.g. violence, property offenses, status offenses, and substance misuse) were attenuated after applying propensity-based inverse probability weights. Participants with a history of juvenile justice involvement were more likely to have later official and violent felony charges, and to self-report police contact and spending time in jail (ORs from 2.5 to 3.3). Residential juvenile justice involvement was associated with the highest risk of both, later official criminal records and self-reported criminality (ORs from 5.1 to 14.5). Sensitivity analyses suggest that our findings are likely robust to potential unobserved confounders.

CONCLUSIONS

Juvenile justice involvement was associated with increased risk of adult criminality, with residential services associated with highest risk. Juvenile justice involvement may catalyze rather than deter from adult offending.

From court to the community: improving access to evidence-based treatment for underserved youth involved in the juvenile legal system at-risk for suicide

BACKGROUND

Juvenile legal involved youth (JLIY) experience disproportionately high rates of suicidal and self-injurious thoughts and behaviors (SSITB). Many JLIY lack access to evidence-based treatment specifically designed to treat SSITB, thereby increasing the overall risk of suicide. The overwhelming majority of JLIY are not placed in secure facilities and almost all incarcerated youth are eventually released to the community. Consequently, SSITB are a major concern of JLIY residing in the community and it is critical that this population has access to evidence-based treatment for SSITB. Unfortunately, most community mental health providers who treat JLIY have not been trained in evidence-based interventions that are specifically designed to SSITB, which often leads to youth experiencing prolonged periods of SSITB. Training community mental health providers who serve JLIY in the detection and treatment of SSITB shows promise for decreasing the overall suicide risk for JLIY.

METHODS

The current proposal aims to reduce SSITB among JLIY, and thus reduce mental health disparities in this vulnerable and underserved youth population, by increasing access to evidence-based treatment strategies specifically designed to treat SSITB behaviors. We will implement an agency-wide training among at least 9 distinct community mental health agencies that serve JLIY referred to treatment by a statewide court system in the Northeast. Agencies will be trained in an adapted version of the COping, Problem Solving, Enhancing life, Safety, and Parenting (COPES+) intervention. Training will be implemented via a cluster-randomized stepped wedge trial that proceeds through multiple phases.

DISCUSSION

This research engages multiple systems (i.e., juvenile legal and mental health systems) serving JLIY and has the potential to directly inform treatment practices in juvenile legal and mental health systems. The current protocol has significant public health implications as the primary goals are to reduce SSITB among adolescents involved in the juvenile legal system. By implementing a training protocol with community-based providers to help them learn an evidence-based intervention, this proposal aims to reduce mental health disparities in a marginalized and underserved population.

TRIAL REGISTRATION

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Suicide in young people: screening, risk assessment, and intervention

Suicide is the fourth leading cause of death among young people worldwide and the third leading cause of death among those in the US. This review outlines the epidemiology of suicide and suicidal behavior in young people. It discusses intersectionality as an emerging framework to guide research on prevention of suicide in young people and highlights several clinical and community settings that are prime targets for implementation of effective treatment programs and interventions aimed at rapidly reducing the suicide rate in young people. It provides an overview of current approaches to screening and assessment of suicide risk in young people and the commonly used screening tools and assessment measures. It discusses universal, selective, and indicated evidence based suicide focused interventions and highlights components of psychosocial interventions with the strongest evidence for reducing risk. Finally, the review discusses suicide prevention strategies in community settings and considers future research directions and questions challenging the field.

Is Violence, Violence no Matter Where it Strikes? Adjudicated Boys, Thwarted Belongingness, Perceived Burdensomeness, and Acquired Capability for Suicide

This study explores treating violence against others as a precursor to self-directed violence. It tests the utility of including violence against others in the measure of acquired capability to test assumptions from the interpersonal theory of violence. Four theoretical hypotheses are assessed that are consistent with the theory: (1) thwarted belongingness (parental abandonment and rejection) and perceived burdensomeness (exposure to parental interpersonal violence and child abuse) independently increase the likelihood of suicidal ideation; (2) the interaction of thwarted belongingness and perceived burdensomeness increases the likelihood of suicidal ideation controlling for other pertinent variables; (3) the three-way interaction of thwarted belongingness, perceived burdensomeness, and acquired capability (violence against others and prior suicidal attempts) increases the likelihood of suicidal attempts controlling for other pertinent variables; and (4) self-harm responds to the theoretical variables and similarly, to attempts. Subjects are court-adjudicated males (ages 13-18) who were residents for up to 1 year at the Ocean Tides School and rehabilitation center from 1975-2019. The data span 44 years and include 2195 youth. Depression, drug/alcohol use, race, ethnicity, socioeconomic status, and interaction terms between SES and race and SES and ethnicity are also examined. Backward conditional logistic regression analyses find mixed support for the hypotheses, but strong support for including violence against others in the concept of acquired capability. Support is also found for conceptualizing child abuse and exposure to parental interpersonal violence as perceived burdensomeness in tests of this theory as well as measures of depression. Major implications for programming in the treatment and rehabilitation of delinquent boys include conceptualizing and approaching violence against others as a precursor to suicidal attempts and other self-directed harm.

Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems

Suicide rates among ethnoracially minoritized youth (i.e., youth of color) peak before the age of 30, and striking disparities in access to mental health services have been identified in this age group. However, suicide prevention strategies have yet to fully address structural racism as a mechanism in producing disparities in risk, protective factors, and access to quality effective intervention for youth of color. Such an approach is critical to provide more culturally responsive mental health care. Through an adapted socio-ecological model, the authors propose the Structural Racism and Suicide Prevention Systems Framework and illustrate pathways through which structural racism impacts suicide prevention and intervention for youth of color in the United States. The authors contextualize the impact of structural racism in three key settings where youth suicide prevention occurs: mental health services, schools, and the interface between crisis care and law enforcement. The authors posit that critical attention must be paid to the intersection of mutually reinforcing, interdependent systems rather than to systems in isolation. The authors then propose recommendations to address structural racism in suicide prevention, including macro-level interventions to improve societal conditions, research strategies to inform structural solutions, training approaches to address institutional racism, and clinical approaches to address the impact of racism and racial trauma on youths and families.

EARLY IDENTIFICATION OF SUICIDE RISK FACTORS AMONG JUSTICE-INVOLVED YOUTH

Suicidal thoughts and behaviors among juvenile justice populations are elevated. However, the characteristics of justice-involved youth who consider and attempt suicide are not well understood. This study examined suicidal ideation and attempt with first-time, preadjudicated diverted youth, and the relationship with commonly associated risk factors. The sample included 135 youth (50% male, M _age = 14.48) that provided complete responses to self-reported lifetime suicidal ideation and attempt items. Analyses examined relationships between suicidal ideation/attempt and mental health, child welfare involvement, delinquency, self-cutting, and substance use. First time, preadjudicated diverted youth reported high rates of lifetime suicidal ideation (27%) and attempt (17%). Suicidal ideation and attempt were associated with sexually minoritized status and self-cutting, while child welfare involvement was only associated with suicidal ideation. This high-risk population would benefit from refined suicide screening and prevention services not always available to justice-involved youth living in the community.

Individual and Contextual Risk and Protective Factors for Suicidal Thoughts and Behaviors among Black Adolescents with Arrest Histories

Black adolescents in the United States have experienced an increase in suicidal thoughts and behaviors (STBs). Since Black adolescents are overrepresented in the youth punishment system, more research is needed to investigate correlates of STBs for this population. The purpose of this paper is to explore and establish correlates of individual, family, and community risk and protective factors and their relationship to lifetime STBs in a national sample of Black youth with arrest histories. Guided by an intersectional eco-behavioral lens, we investigated individual, family and contextual risk and protective factors for STBs among a national sample of justice-involved Black youth aged 12-17 with a history of arrest (n = 513). We used logistic regression models to test risk and protective factors for STBs. Among the sample, 9.78% endorsed suicidal ideation, and 7.17% endorsed a previous suicide attempt. Further, gender (female) and depression severity were risk factors for STBs, while positive parenting and religiosity were protective factors for STBs. School engagement was associated with lower levels of suicidal ideation. The findings suggest suicide prevention and intervention efforts should identify developmentally salient risk and protective factors to reduce mental health burden associated with STBs and concurrent alleged law-breaking activity of Black youth.

Suicide Screening Among Youth at First Court Contact

Youth involved in the juvenile justice system are at elevated risk for suicide and co-occurring mental health symptoms. This study aims to examine the suicide risk and treatment needs of court-involved, non-incarcerated (CINI) youth, and to understand the acceptability and effectiveness of implementing a mental health screening procedure at time of first court contact. By embedding a forensic mental health screening tool into the intake process of a family court diversionary program, a total of 891 youth (aged 12-18) were assessed using the Massachusetts Youth Screening Instrument-2 (MAYSI-2). Analysis of screening responses revealed 12.5% of youth indicated risk for suicide with risk levels differentiated by youth sex, race and ethnicity. Suicide ideation was also significantly associated with flagging, an indication of clinical risk, on all other scales of the MAYSI-2, as well as subsequent referrals to treatment. Screening for suicide at first point of court contact within an existing diversionary program may serve as a critical and effective point of intervention for youth in need.

Suicide Risk, Self-Injury, and Sleep: An Exploration of the Associations in a Sample of Juvenile Justice Involved Adolescents

Court-involved youth living in the community represent a vulnerable, yet understudied, group that is at risk for a variety of concerning outcomes including increased suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI). Additionally, sleep disruption, which has been associated with an increase in impulsive decision making, appears to be disproportionately high in this population. However, little is known about any connection between poor sleep and increased suicide risk and NSSI in a group of youth. This study explores the associations between sleep disruption, suicidal ideation, suicide attempts, and NSSI in a sample of court-involved youth in the community referred for mental health evaluation at a court based mental health clinic. Findings suggest that sleep disruption is related to NSSI in this population but not suicidal ideation and suicide attempts. Additional relationships were found between NSSI and being female, as well as having a lifetime history of trauma and marijuana use. Findings suggest that court clinics may wish to screen for sleep disruption as a risk factor for NSSI, and future studies may wish to explore improved sleep as a protective factor for CINI youth.

Equitable suicide prevention for youth impacted by the juvenile legal system

Suicide is the second leading cause of death for adolescents in the United States. Despite the already alarmingly high rates of suicide attempts among adolescents, youth involved in the juvenile legal system (JLS) are up to three times more likely to have suicide attempts than their peers not impacted by the JLS. This public health crisis is also a matter of health equity, knowing that ethnoracially minoritized youth, mainly Black and Latinx youth, have disproportionate contact with the JLS. In order to disrupt the current elevated rates of suicide among Black and Latinx youth involved in the JLS, there needs to be more concerted efforts to improve assessment and suicide prevention efforts in the JLS. There are various potential touch points of care for suicide prevention and the Sequential Intercept Model (SIM), which outlines community-based responses to the involvement of people with mental and substance use disorders in the criminal justice system, can be used as a strategic planning tool to outline possible equitable interventions across these various touch points. Our purpose is to provide a comprehensive picture of gaps and equitable opportunities for suicide prevention across each intercept of the SIM. We provide recommendations of priorities to promote health equity in suicide prevention for ethnoracially minoritized youth impacted by the JLS.

Do suicidal thoughts and behavior persist following juvenile justice involvement?

INTRODUCTION

This study examines suicidal ideation and behavior of youth in the 3 months following their initial diversion appointment in the juvenile justice system.

METHOD

Participants were 99 adolescents (72.7% female; 65% racial minority) between the ages of 12 and 18 (Mage = 15.06, SD = 1.35) and a parent/caregiver (80% female; 54% racial minority; Mage = 42.7 years, SD = 8.9 years). Participants were eligible if they endorsed two or more suicide items on a mental health screener (MAYSI-2) and were able to be contacted 3 months following initial court appointment. Youth and parent/caregiver responded to questionnaires assessing SI/SA, psychiatric symptoms, treatment motivation and engagement.

RESULTS

Three months post-initial court appointment, more than half of youth (55.5%) continued to flag on the Suicide Ideation subscale of the MAYSI-2, though mean scores decreased from baseline to 3-months (t[97] = 5.74, p < 0.000, 95% CI [-0.79, 1.62] Cohen's d = 0.77). There were no significant differences in parent/youth treatment motivation or engagement regardless of SI at 3 months.

CONCLUSIONS

Persistence of suicidal thoughts and behaviors beyond initial legal involvement highlights the importance of targeted suicide prevention interventions (beyond screening and referral to treatment) with justice-involved youth, even at first court contact.

Characteristics of suicides of young people in Porto Alegre, Southern Brazil, from 2010 to 2016

The purpose of this study was to describe demographic, toxicological, criminal, and medicolegal characteristics of suicides of young people aged up to 24 years examined by the Porto Alegre Medicolegal Office, from 2010 to 2016. This cross-sectional study collected data from the Porto Alegre Medicolegal Office and the Rio Grande do Sul State Police Department. The information was obtained from death certificates, toxicological analyses and police reports. Rates were calculated according to sex and age range (under 15 years old, 15 to 19 years old, and 20 to 24 years old) for comparing local with national data. There were 143 people who died by suicide in the period, 120 males and 23 females. Hanging was the most frequently used method, but in the range of 10 to 14 years old, firearm use was the predominant method. Fifty percent of male victims and 30% of female victims had some criminal history. Suicide rates in the study groups generally followed national trends. The relative frequency of suicide by firearm in this study diverged from international findings, as it was relatively more frequent in children under 15 years old and less frequent in older ranges. If confirmed, the finding draws attention to access to firearms in this age range. In older age ranges, adolescents and young adults were frequently involved in the criminal system. This finding may be useful for planning interventions involving both mental health education and screening for problems that may be associated with criminal involvement.

Assessment of suicide probability and related factors in male incarcerated adolescents; a sample of reformatory center in Turkey

OBJECTIVE

Suicidal behavior in adolescents is an important public health problem, and it ranks first among the causes of prison deaths in incarcerated adolescents(IAs). The aim of this study is to determine the probability of suicide and associated risk factors in IAs.

METHOD

Seventy-one male adolescents in a reformatory center were contrasted with a matched group of 71 male adolescent with no psychiatric disorder and no criminal record. Suicidal probability and psychiatric symptomatology were assessed with the Suicide Probability Scale, SA-45 Questionnaire, respectively.

RESULTS

It was determined that the probability of suicide was higher in IAs, and depression and hostility symptoms, the presence of another individual involved in delinquency in family had predictive effects. It was also found that there was a positive correlation between the probability of suicide and the number of delinquencies, the number of incarceration, and a negative correlation between attending to school or work while in reformatory and being visited by relatives while in reformatory.

CONCLUSIONS

The results suggest that when assessing suicide risk for IAS, it may be useful to pay attention to those with symptoms of depression or hostility, those with multiple delinquencies or entrance to reformatory, and those who have family members involved in delinquency.

Suicide after reception into prison: A case-control study examining differences in early and late events

OBJECTIVE

Prisoners constitute a high-risk group for suicide, with suicide rates about 5 to 8 times higher than in the general population. The first weeks of imprisonment are a particularly vulnerable time, but there is limited knowledge about the risk factors for either early or late suicide events.

METHODS

Based on a national total sample of prison suicides in Germany between 2005 and 2017, suicides within the first 2 (4 and 8) weeks after reception into prison were matched by age and penalty length with cases that occurred later. Factors that potentially influence the timing of suicide were investigated.

RESULTS

The study has shown that 16.7% (31.5%) of all 390 suicides in German prisons occurred within the first two weeks (two months) of imprisonment. Factors that facilitate adaptation to the prison environment (e.g. prior prison experience) were negatively associated with early suicide events. Factors that hindered the adaptation process (e.g. withdrawal from illicit drugs) were observed more frequently in early suicide events than in late ones. These factors are active at different times of imprisonment.

CONCLUSION

At reception, particular attention should be paid to the following factors associated with early suicide events: widowed marital status, lack of prison experience, and drug dependency.

Maladaptive coping, victimization, and recidivism among Japanese adolescents and emerging adults

BACKGROUND

Substance use and victimization are known to be related to juvenile recidivism. Self-harm, a factor that commonly accompanies substance use and victimization, is not known to be related to said recidivism but may be so in a welfare-oriented juvenile justice system as found in Japan.

OBJECTIVE

We examine the extent to which maladaptive coping, comprising substance use and self-harm, increases the rate of persistence in correctional institutions in light of other well-replicated factors of youth recidivism. The study, too, investigates the role of maladaptive coping in explaining the impact of victimization on correctional recidivism.

METHODS

We draw from a sample of 348 adolescents and emerging adults, between ages 12-19 years, who were initially detained at a Juvenile Classification Home and followed-up for an average of 3.35 years.

RESULTS

Findings indicate that maladaptive coping is significantly related to persistence in the system, although history of probationary supervision and gang membership also were significant explanatory factors. In addition, the direct effect of victimization was larger than the indirect effect of victimization through maladaptive coping.

CONCLUSIONS

Unlike previous studies, self-harm is significantly related to recidivism. This suggests that recidivism reflects a need for help more so than for punishment. The wider implications are that juvenile justice systems characterized as punitive seem outdated in managing detained young people as they lack adequate prevention supports.

Statewide Trends of Trauma History, Suicidality, and Mental Health Among Youth Entering the Juvenile Justice System

PURPOSE

This study used Washington statewide administrative data to document the prevalence and trend of trauma history, suicidality, and mental health problems among all youth ordered to probation for the first time between 2011 and 2015. We also examined the extent to which trauma and mental health problems were associated with youth suicide risk during this time.

METHODS

More than 16,500 youth started probation (2011-2015) and received a standardized risk assessment. We used descriptive statistics to assess the prevalence of trauma history, suicidality, mental health problems, and overall risk to reoffend. We then used multilevel logistic regression models (youth within counties) to assess each measure's association with suicidality.

RESULTS

About 80% of the youth had a history of at least one traumatic experience. As fewer youth started probation for the first time each year, the prevalence of trauma, suicidality, mental health problems, and overall risk to reoffend increased. Trauma, mental health, and overall risk were significantly associated with suicide risk among probation youth.

CONCLUSIONS

This epidemiological study is expected to motivate discussion around the best ways to integrate trauma-informed care and suicide prevention in the juvenile justice system.

Health Needs of Youth in Detention With Limited Justice Involvement

Although incarcerated youth (i.e., youth sentenced to secure custody) have high health needs, the health of detained youth with limited justice involvement remains poorly understood. Between September 2018 and February 2019, social workers from the Los Angeles County Whole Person Care Juvenile Reentry Aftercare Program (WPC) assessed the health and social needs of youth in pre-trial detention. We partnered with the WPC team to analyze assessments completed by 83 youth participants. Youth were on average 16 years old, most (83%) identified as male, and all were from racial or ethnic minority groups. Participants reported high behavioral health needs, including a high prevalence of prior suicide attempts (16%) and history of substance use (81%). Participants demonstrated a pattern of crisis healthcare utilization. Youth also indicated areas of strength, including personal positive traits, engagement in extracurricular activities, educational achievements, and having multiple sources of social support. The majority of youth (74%) desired vocational training and nearly all (94 %) wanted to return to school after release. Overall, the findings indicate that detained youth with limited involvement in the justice system are a resilient group that have notably higher health risk than same-age peers, signifying a critical opportunity for intervention.

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.

Evaluation of a Suicide Risk Assessment Tool in a Large Sample of Detained Youth

OBJECTIVES

We evaluated the six-item Inmate Security Assessment (ISA) tool used among detained youth in Manitoba, Canada.

METHOD

Two hundred and forty-one recorded self-harm incidents among all incarcerated youth occurred between January 1, 2005 and December 31, 2010 (N=5102). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) for three categories of suicide risk (high, medium, and low) as well as each of the six suicide risk evaluation indicators were determined. Receiver operating characteristic (ROC) curves and area under the curve (AUC) calculations for the three suicide risk levels and the six indicators were created.

RESULTS

Having at least a low suicide risk level (93.8%) or at least one suicide risk factor (94.6%) provided high sensitivity. Specificity was high if an individual had at least a medium suicide risk level (94.2%) or at least three suicide risk indicators (96.7%). The PPV was low (8.9-16.2%) and the NPV was high (94.9-99.3%) for all suicide risk levels. The most sensitive risk factor for self-harm was a prior history of suicidal behavior or a family history of suicide (94.6%). All risk indicators had a low PPV (7.4-23.1%) and a high NPV (95.4-99.5%). A very low NLR was found for those without prior suicidal behavior or a family history of suicide (0.107). The AUC was 0.719 (95%CI = 0.692-0.746), indicating a fair test.

CONCLUSION

The ISA is a moderately accurate tool for identifying risk for self-harm in detained youth.

Depression in Justice-involved Youth

Justice-involved youth are at exceedingly high risk of trauma exposure, multisystem involvement, and mental health distress, including depression. Justice-involved youth carry with them both a high symptom burden and a high cost to society. Both could be reduced through evidence-based prevention and treatment strategies. Effective treatment of mental disorders may reduce future justice involvement, whereas lack of treatment increases likelihood of justice involvement into adulthood. Multiple effective programs exist to improve the lives of justice-involved youth and subsequently decrease the cost to society of detaining and adjudicating these youth within the juvenile justice system.

Juvenile justice systems of care: results of a national survey of community supervision agencies and behavioral health providers on services provision and cross-system interactions

BACKGROUND

Youth involved in the juvenile justice (JJ) system have high needs for behavioral health services, especially related to substance use and mental disorders. This study aimed to understand the extent to which elements in the cascade model of behavioral health services for JJ-involved youth are provided to youth by Community Supervision (CS) and/or Behavioral Health (BH) providers. In order to understand interactions across CS and BH systems, this study used a multistage probabilistic survey design to sample CS agencies and their primary BH service providers of substance use and mental health treatment in the United States. Parallel surveys were administered to both CS and BH providers regarding: characteristics of youth served, BH services available, whether services were provided directly and/or by referral, use of evidence-based practices (EBPs), and methods of collaboration, referral, and information exchange across CS and BH providers.

RESULTS

The findings from weighted national estimates demonstrate that youth referred from CS to the BH programs represent a more severe sub-group of youth under CS supervision. There are established cross-system relationships for assessment and referral for substance use and mental health treatment, but less so for prevention services. Most CS programs refer youth to BH providers for these services, which typically utilize more highly trained staff to provide EBPs to a majority of the youth served. More intensive substance use and mental health treatment, aftercare, and recovery support services were limited in availability.

CONCLUSIONS

The findings suggest that although many elements in a cascade model of BH services for JJ-involved youth have been implemented within local systems of care through collaboration between CS and BH providers, there are several underdeveloped areas and potential for attrition across the service cascade. Greater attention to providing services to youth with higher levels of severity, aftercare services, and recovery support is warranted within a multi-systemic framework.

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.

Psychopathy and Suicidal Thoughts and Behaviors Revisited: Results From a Statewide Population of Institutionalized Youth

Suicide is the leading cause of death for incarcerated youth, and up to half of all juveniles in confinement experience suicidal ideation in addition to other psychopathology, including psychopathic personality features. Unfortunately, limited research has investigated the psychopathy-suicidality link among juvenile delinquents and using newer psychopathy measures. Based upon a statewide population of incarcerated juvenile offenders, we found that psychopathy was a significant risk factor for suicidal ideation and lifetime suicide attempts, but the latter relationship was attenuated by lifetime depression diagnosis. In addition, certain affective psychopathic features such as Stress Immunity conferred protection against suicidality, whereas behavioral and lifestyle components including Carefree Nonplanfulness, Blame Externalization, and Rebellious Nonconformity were positively linked to suicidal thoughts among the youth offenders. As these risk factors are routinely screened for in juvenile justice settings, this study's findings have considerable implications to applied practice and prevention among juvenile justice involved youth.

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.

Think, Ask, Act: The Intersectionality of Mental and Reproductive Health for Judicially Involved Girls

Danielle Smith, a 16-year-old African-American girl newly detained at juvenile hall, presents for psychiatric evaluation. She describes a history of sexual abuse by her foster father and 2 years of commercial sexual exploitation after running away at 14 years of age. Scarcely more than 100 pounds, she endorses drug use, primarily marijuana, and notes prior use of cocaine and methamphetamine, provided by her trafficker (described as her "boyfriend"). She has a timid smile and uses music and journaling as her refuge. Danielle is unclear about past psychiatric diagnoses but does recall receiving medication from a psychiatrist while in foster care and expresses interest in resuming treatment. Girls in the juvenile justice system are a vulnerable population with overlapping substance use, reproductive, and mental health care needs. The conceptual framework of "intersectionality" is useful to better understand the multiplicity of biopsychosocial needs of girls involved in the justice system. Intersectionality is defined as "a theoretical framework for understanding how multiple social identities (ie, race, gender, and sexual orientation) intersect at the micro level of individual experience to reflect systems of oppression (ie, racism, sexism, classism) at the macro level."1 In this article, we propose the pragmatic application of the concept of intersectionality to better conceptualize the high unmet health needs of these youth. We conclude by providing recommendations for meeting their needs using the proposed "think, ask, act" approach.

Childhood Trauma and Psychopathic Features Among Juvenile Offenders

Despite growing interest in psychopathic personality features in juvenile offenders, few studies have examined the relationship between childhood trauma and psychopathy. The present study utilized two datasets: 253 adolescents in a residential facility for juvenile offenders in Pennsylvania and 723 institutionalized delinquents in Missouri. Zero-order correlations and linear regression techniques were employed for boys and girls to examine the relationships between trauma, assessed using the Massachusetts Youth Screening Instrument Version 2 (MAYSI-2) Traumatic Experiences Scale and the Childhood Trauma Questionnaire (CTQ), and psychopathy as measured by the Youth Psychopathic Traits Inventory (YPI) and the Psychopathic Personality Inventory-Short Form (PPI-SF). Results indicate that psychopathy is significantly correlated with childhood trauma. For the Missouri data, trauma significantly predicted psychopathy scores for both boys and girls. These results suggest that nuanced understanding of traumatic history of these adolescents may not only be a pathway to psychopathy but also a critical part of their overall assessment and treatment plan.

Screening for mental health needs of New Zealand youth in secure care facilities using the MAYSI-2

BACKGROUND

Young people admitted to secure facilities generally have particularly high rates of mental, emotional and behavioural problems, but little is known about the mental health needs of this group in New Zealand.

AIMS

To describe prevalence of probable mental health disorder and related needs among young people in secure facilities in New Zealand.

METHODS

Massachusetts youth screening instrument - second version (MAYSI-2) data were obtained from the records of young people admitted to one secure care facility (n = 204) within a 12 month period. We used descriptive statistics to determine prevalence of problems overall and multivariate analysis of variance to compare MAYSI-2 scores between gender and ethnic groups.

RESULTS

Nearly 80% of these young people scored above the 'caution' or 'warning' cut-off on the MAYSI-2, a substantially higher proportion than reported in studies in other countries. There was a tendency for girls and for Maori and Pacific Islander subgroups to have a higher rate of probable psychopathology.

CONCLUSIONS

Young people in secure facilities in New Zealand have substantial service needs. Early intervention that engages them in services upon first contact with the youth justice system might help reduce this burden. Further validation of the MAYSI-2 in New Zealand may be warranted because of the unique ethnic make-up of these young offenders. Copyright © 2017 John Wiley & Sons, Ltd.

Measures of frequency used in cohorts studies to evaluate the suicidal behaviour in young people (12-26 years): A systematic review

INTRODUCTION

A priority for the WHO by 2020 is to have reduced the rates of suicide; they indicate difficulties in giving precise estimations due to a wide variety of factors, which include aspects related to the statistical measurements themselves of suicidal behaviour. The proportion of deaths from suicide is 8.5% among young people between 15-29 years of age.

OBJECTIVE

To review the methodology used to express the frequency of suicidal behaviour in young people and to describe the methodological characteristics of the studies reviewed.

METHOD

A systematic review of longitudinal studies registered on PROSPERO. The extracted information included the following: year of publication, journal, population size, sample, country, design, age, percentage of men, follow-up time and losses, suicidal behaviour, risk factors, ethical aspects, fundamentally, evaluating the measures of frequency used.

RESULTS

Eighty-two articles were selected from 37,793 documents. None of the studies define the measure of frequency used for suicidal behaviour, there are currently up to 9 different ways of measuring it. The populations are students or the general population (66%), birth cohorts (16%) and specific groups. Follow-up was from 24 weeks to 30 years. Only 24.1% of the studies took ethical aspects into consideration.

CONCLUSIONS

Researchers must make an effort to reach an agreement on the measures of frequency used in suicidal behaviour studies, as the methodological and terminological variability currently used impedes making any comparisons between different studies or understanding the real dimension of the problem.

Childhood trauma and risk for suicidal distress in justice-involved children

Justice-involved children (JIC) have higher rates of trauma exposure and suicidality than the general population. The Childhood Trauma Model predicts that children can accumulate multiple traumatic experiences that can be more harmful than a single traumatic event. The purpose of this study is to investigate the individual and cumulative effects of childhood trauma on suicidal distress among JIC. The study employs logistic regression to analyze panel data on 2367 12-16 year-olds from the Florida Department of Juvenile Justice (FLDJJ). The study shows that 9 types of individual traumatic experiences increased risk for suicidal ideation from 22 to 180%. For one unit increase in the trauma score, the risk for suicidal distress increased 25%, so that JIC who experienced 5 types of traumas were 2.4 times more likely to experience suicidal distress as JIC who experienced a single trauma. These findings illustrate the need to invest mental health services and suicide prevention resources in populations in the juvenile justice system. Intervention must be tailored to serve children who suffered specific traumatic events, as well as those who experience multiple types of trauma. Further, policies that manage JIC as kid criminals rather than as traumatized children may exacerbate their suicidality and problematic behavior.

Adolescents' Perceptions of a Gardening Activity at a Juvenile Justice Center

PURPOSE

The purpose of this study was to elicit participants' ( N = 16) perceptions of a gardening activity at a juvenile justice center and to determine whether past exposure to gardening and farmers markets was associated with their perceptions of the gardening experience.

DESIGN

This cross-sectional, exploratory program evaluation was conducted in partnership with the Kentucky Department of Juvenile Justice. Adolescents completing the Cadet Leadership and Education Program participated in gardening in order to provide produce to a local farmers' market.

METHOD

After the growing season, participants were asked to complete a nine-item questionnaire about the gardening activity during one of their usual classes at the facility. The questionnaire assessed perception of the experience and past exposure to gardening and farmers' markets.

FINDINGS

Participants reported favorably about their participation in the activity, knowledge gained from the activity, and their intent to garden in the future. Those who had previously gardened had more favorable perception of gardening than those who had never gardened. Gardening is an inexpensive means of teaching teamwork and delayed gratification and providing a sense of empowerment and may benefit at-risk adolescents during incarceration.

Suicidal ideation while incarcerated: Prevalence and correlates in a large sample of male prisoners in Flanders, Belgium

Prisoners constitute a high-risk group for suicide. As an early stage in the pathway leading to suicide, suicidal ideation represents an important target for prevention, yet research on this topic is scarce in general prison populations. Using a cross-sectional survey design, correlates of suicidal ideation while incarcerated were examined in a sample of 1203 male prisoners, randomly selected from 15 Flemish prisons. Overall, a lifetime history of suicidal ideation and attempts was endorsed by 43.1% and 20.3% of respondents, respectively. Approximately a quarter of all prisoners (23.7%) reported past-year suicidal ideation during their current incarceration, which was significantly associated with both imported vulnerabilities (psychiatric diagnoses and a history of attempted suicide) and variables unique to the prison experience (lack of working activity, exposure to suicidal behaviour by peers, and low levels of perceived autonomy, safety and social support) in the multivariate regression analysis. A first-ever period of imprisonment and a shorter length of incarceration (≤12months) were also associated with increased odds of recent suicidal ideation. Collectively, the current findings underscore the importance of both vulnerability factors and prison-specific stressors for suicidal ideation in prisoners, and hence the need for a multi-faceted approach to suicide prevention in custodial settings. In addition to the provision of appropriate mental health care, environmental interventions that target modifiable aspects of the prison regime could provide a substantial buffer for the onset and persistence of suicidal ideation in this at-risk population.

Disproportionality and Disparities among Sexual Minority Youth in Custody

Research indicates that sexual minority youth are disproportionately criminalized in the U.S. and subjected to abusive treatment while in correctional facilities. However, the scope and extent of disparities based on sexual orientation remains largely overlooked in the juvenile justice literature. This study, based on a nationally representative federal agency survey conducted in 2012 (N = 8785; 9.9% girls), reveals that 39.4% of girls and 3.2% of boys in juvenile correctional facilities identified as lesbian, gay, or bisexual. These youth, particularly gay and bisexual boys, report higher rates of sexual victimization compared to their heterosexual peers. Sexual minority youth, defined as both lesbian, gay, and bisexual identified youth as well as youth who identified as straight and reported some same-sex attraction, were also 2-3 times more likely than heterosexual youth to report prior episodes of detention lasting a year or more. Implications for future research and public policy are discussed.

Adolescent health and subsequent risk of self-harm hospitalisation: a 15-year follow-up of the Young-HUNT cohort

BACKGROUND

Self-harm is associated with increased suicide risk, and constitutes a major challenge in adolescent mental healthcare. In the current study, we examined the association between different aspects of adolescent health and risk of later self-harm requiring hospital admission.

METHODS

We linked baseline information from 13 to 19 year old participants (n = 8965) in the Norwegian Young-HUNT 1 study to patient records of self-harm hospitalisation during 15 years of follow-up. We used Cox regression to estimate risk factor hazard ratios (HR).

RESULTS

Eighty-nine persons (71% female) were admitted to hospital because of self-harm. Intoxication/self-poisoning was the most frequent method (81%). Both mental (anxiety/depression, loneliness, being bullied) and somatic (epilepsy, migraine) health issues were associated with up to fourfold increased risk of self-harm-related hospital admission.

CONCLUSIONS

Several health issues during adolescence markedly increased the risk of later self-harm hospitalisation. Current findings should be incorporated in the strive to reduce self-harming and attempted suicides among young people.

Mass incarceration, public health, and widening inequality in the USA

In this Series paper, we examine how mass incarceration shapes inequality in health. The USA is the world leader in incarceration, which disproportionately affects black populations. Nearly one in three black men will ever be imprisoned, and nearly half of black women currently have a family member or extended family member who is in prison. However, until recently the public health implications of mass incarceration were unclear. Most research in this area has focused on the health of current and former inmates, with findings suggesting that incarceration could produce some short-term improvements in physical health during imprisonment but has profoundly harmful effects on physical and mental health after release. The emerging literature on the family and community effects of mass incarceration points to negative health impacts on the female partners and children of incarcerated men, and raises concerns that excessive incarceration could harm entire communities and thus might partly underlie health disparities both in the USA and between the USA and other developed countries. Research into interventions, policies, and practices that could mitigate the harms of incarceration and the post-incarceration period is urgently needed, particularly studies using rigorous experimental or quasi-experimental designs.