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Luna MJ, Abram KM, Aaby DA, Welty LJ, Teplin LA. Inequities in Mental Health Services: A 16-Year Longitudinal Study of Youth in the Justice System. J Am Acad Child Adolesc Psychiatry 2024; 63:422-432. [PMID: 37516236 PMCID: PMC10818024 DOI: 10.1016/j.jaac.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/30/2023] [Accepted: 07/20/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE To examine: (1) if youth who have mental health disorders receive needed services after they leave detention-and as they age; and (2) inequities in service use, focusing on demographic characteristics and type of disorder. METHOD We used data from the Northwestern Juvenile Project, a longitudinal study of 1,829 youth randomly sampled from detention in Chicago, Illinois in 1995. Participants were re-interviewed up to 13 times through 2015. Interviewers assessed disorders using structured diagnostic interviews and assessed service use using the Child and Adolescent Service Assessment and the Services Assessment for Children and Adolescents. RESULTS Less than 20% of youth who needed services received them, up to median age 32 years. Female participants with any disorder had nearly twice the odds of receiving services compared with male participants (OR: 1.82; 95% CI: 1.41, 2.35). Compared with Black participants with any disorder, non-Hispanic White and Hispanic participants had 2.14 (95% CI: 1.57, 2.90) and 1.50 (95% CI: 1.04, 2.15) times the odds of receiving services. People with a disorder were more likely to receive services during childhood (< age 18) than during adulthood (OR: 2.29; 95% CI: 1.32, 3.95). Disorder mattered: participants with an internalizing disorder had 2.26 times and 2.43 times the odds of receiving services compared with those with a substance use disorder (respectively, 95% CI: 1.26, 4.04; 95% CI: 1.49, 3.97). CONCLUSION Few youth who need services receive them as they age; inequities persist over time. We must implement evidence-based strategies to reduce barriers to services.
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Affiliation(s)
- María José Luna
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karen M Abram
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David A Aaby
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leah J Welty
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Linda A Teplin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Stokes ML, Abram KM, Aaby DA, Welty LJ, Meyerson NS, Zawitz CJ, Teplin LA. Substance Use Disorders and HIV/AIDS Risk Behaviors in Youth After Juvenile Detention: A 16-Year Longitudinal Study. J Adolesc Health 2023; 73:640-649. [PMID: 37716716 PMCID: PMC10513729 DOI: 10.1016/j.jadohealth.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/27/2023] [Accepted: 05/10/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE To examine the association between substance use disorders (SUDs) and HIV/AIDS risk behaviors in detained youth as they age. METHODS Prospective longitudinal study of a stratified random sample of 1,829 youth aged 10 to 18 years at baseline, sampled between November 1995 and June 1998 from the Cook County Juvenile Temporary Detention Center, Chicago, Illinois, and reinterviewed up to 13 times (to median age 32); 17,766 interviews overall. RESULTS Youth had greater odds of engaging in every risk behavior when they had an SUD compared with when they did not have an SUD. For example, SUD was associated with condomless vaginal sex with a high-risk partner (OR: 2.28, 95% CI: 1.84-2.82). SUD was also associated with multiple partners, although the strength varied by time and sex (e.g., 16 years after baseline, OR: 3.58, 95% CI: 2.46-5.23 females; OR: 2.07, 95% CI: 1.48-2.88 males). Types of SUD-alcohol, comorbid alcohol and marijuana, drugs other than marijuana-were also associated with HIV/AIDS risk behaviors. DISCUSSION SUDs and HIV/AIDS risk behaviors are linked among youth in the juvenile justice system and as they age. There is a longstanding need for targeted and integrated HIV and SUD services, but this need remains unmet.
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Affiliation(s)
- Marquita L Stokes
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karen M Abram
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - David A Aaby
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leah J Welty
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nicholas S Meyerson
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Chad J Zawitz
- Cermak Health Services, Cook County Department of Corrections, Chicago, Illinois; Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Linda A Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Teplin LA, Abram KM, Luna MJ. Racial and Ethnic Biases and Psychiatric Misdiagnoses: Toward More Equitable Diagnosis and Treatment. Am J Psychiatry 2023; 180:402-403. [PMID: 37259513 DOI: 10.1176/appi.ajp.20230294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Linda A Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago
| | - Karen M Abram
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago
| | - María José Luna
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago
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Zheng N, Abram KM, Welty LJ, Aaby DA, Meyerson NS, Teplin LA. Nonfatal Firearm Injury and Firearm Mortality in High-risk Youths and Young Adults 25 Years After Detention. JAMA Netw Open 2023; 6:e238902. [PMID: 37083667 PMCID: PMC10122168 DOI: 10.1001/jamanetworkopen.2023.8902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Importance Youths, especially Black and Hispanic males, are disproportionately affected by firearm violence. Yet, no epidemiologic studies have examined the incidence rates of nonfatal firearm injury and firearm mortality in those who may be at greatest risk-youths who have been involved with the juvenile justice system. Objectives To examine nonfatal firearm injury and firearm mortality in youths involved with the juvenile justice system and to compare incidence rates of firearm mortality with the general population. Design, Setting, and Participants The Northwestern Juvenile Project is a 25-year prospective longitudinal cohort study of 1829 youths after juvenile detention in Chicago, Illinois. Youths were randomly sampled by strata (sex, race and ethnicity, age, and legal status [juvenile or adult court]) at intake from the Cook County Juvenile Temporary Detention Center. Participants were interviewed at baseline (November 1995 to June 1998) and reinterviewed as many as 13 times over 16 years, through February 2015. Official records on mortality were collected through December 2020. Data analysis was conducted from November 2018 to August 2022. Main Outcomes and Measures Participants self-reported nonfatal firearm injuries. Firearm deaths were identified from county and state records and collateral reports. Data on firearm deaths in the general population were obtained from the Illinois Department of Public Health. Population counts were obtained from the US census. Results The baseline sample of 1829 participants included 1172 (64.1%) males and 657 (35.9%) females; 1005 (54.9%) Black, 524 (28.6%) Hispanic, 296 (16.2%) non-Hispanic White, and 4 (0.2%) from other racial and ethnic groups (mean [SD] age, 14.9 [1.4] years). Sixteen years after detention, more than one-quarter of Black (156 of 575 [27.1%]) and Hispanic (103 of 387 [26.6%]) males had been injured or killed by firearms. Males had 13.6 (95% CI, 8.6-21.6) times the rate of firearm injury or mortality than females. Twenty-five years after the study began, 88 participants (4.8%) had been killed by a firearm. Compared with the Cook County general population, most demographic groups in the sample had significantly higher rates of firearm mortality (eg, rate ratio for males, 2.8; 95% CI, 2.0-3.9; for females: 6.5; 95% CI, 3.0-14.1; for Black males, 2.5; 95% CI, 1.7-3.7; for Hispanic males, 9.6; 95% CI, 6.2-15.0; for non-Hispanic White males, 23.0; 95% CI, 11.7-45.5). Conclusions and Relevance This is the first study to examine the incidence of nonfatal firearm injury and firearm mortality in youths who have been involved with the juvenile justice system. Reducing firearm injury and mortality in high-risk youths and young adults requires a multidisciplinary approach involving legal professionals, health care professionals, educators, street outreach workers, and public health researchers.
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Affiliation(s)
- Nanzi Zheng
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karen M Abram
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leah J Welty
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David A Aaby
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nicholas S Meyerson
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Linda A Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Teplin LA, Potthoff LM, Aaby DA, Welty LJ, Dulcan MK, Abram KM. Prevalence, Comorbidity, and Continuity of Psychiatric Disorders in a 15-Year Longitudinal Study of Youths Involved in the Juvenile Justice System. JAMA Pediatr 2021; 175:e205807. [PMID: 33818599 PMCID: PMC8022269 DOI: 10.1001/jamapediatrics.2020.5807] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/01/2020] [Indexed: 12/26/2022]
Abstract
Importance Previous studies have found that one-half to three-quarters of youths detained in juvenile justice facilities have 1 or more psychiatric disorders. Little is known about the course of their disorders as they age. Objective To examine the prevalence, comorbidity, and continuity of 13 psychiatric disorders among youths detained in a juvenile justice facility during the 15 years after detention up to a median age of 31 years, with a focus on sex and racial/ethnic differences. Design, Setting, and Participants The Northwestern Juvenile Project is a longitudinal cohort study of health needs and outcomes of 1829 randomly selected youths in a temporary juvenile detention center in Cook County, Illinois. Youths aged 10 to 18 years were interviewed in detention from November 20, 1995, through June 14, 1998. Participants were reinterviewed up to 12 times during the 15-year study period through February 2015, for a total of 16 372 interviews. The sample was stratified by sex, race/ethnicity (Black, Hispanic, and non-Hispanic White), age (10-13 years or 14-18 years), and legal status (processed in juvenile or adult court). Data analysis was conducted from February 2014, when data preparation began, to March 2020. Exposures Detention in a juvenile justice facility. Main Outcomes and Measures Psychiatric disorders, assessed by the Diagnostic Interview Schedule for Children, version 2.3 at the baseline interviews. Follow-up interviews were conducted using the Diagnostic Interview Schedule for Children, version IV; the Diagnostic Interview Schedule, version IV; and the World Mental Health Composite International Diagnostic Interview (beginning at the 6-year follow-up interview). Results The study included 1829 youths sampled at baseline (1172 males and 657 females; mean [SD] age, 14.9 [1.4] years). Although prevalence and comorbidity of psychiatric disorders decreased as the 1829 participants aged, 52.3% of males and 30.9% of females had at least 1 or more psychiatric disorders 15 years postdetention. Among participants with a disorder at baseline, 64.3% of males and 34.8% of females had a disorder 15 years later. Compared with females, males had 3.37 times the odds of persisting with a psychiatric disorder 15 years after baseline (95% CI, 1.79-6.35). Compared with Black participants and Hispanic participants, non-Hispanic White participants had 1.6 times the odds of behavioral disorders (odds ratio, 1.56; 95% CI, 1.27-1.91 and odds ratio, 1.59; 95% CI, 1.23-2.05, respectively) and greater than 1.3 times the odds of substance use disorders (odds ratio, 1.90; 95% CI, 1.55-2.33 and odds ratio, 1.39; 95% CI, 1.11-1.73, respectively) throughout the follow-up period. Behavioral disorders and substance use disorders were the most prevalent 15 years after detention. Conclusions and Relevance This study's findings suggest that persistent psychiatric disorders may complicate the transition from adolescence to adulthood, which is already challenging for youths involved in the juvenile justice system, many of whom are from racial/ethnic minority groups and low-income backgrounds. The pediatric health community should advocate for early identification and treatment of disorders among youths in the justice system.
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Affiliation(s)
- Linda A. Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lauren M. Potthoff
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David A. Aaby
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leah J. Welty
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mina K. Dulcan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Karen M. Abram
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Teplin LA, Meyerson NS, Jakubowski JA, Aaby DA, Zheng N, Abram KM, Welty LJ. Association of Firearm Access, Use, and Victimization During Adolescence With Firearm Perpetration During Adulthood in a 16-Year Longitudinal Study of Youth Involved in the Juvenile Justice System. JAMA Netw Open 2021; 4:e2034208. [PMID: 33538822 PMCID: PMC7862991 DOI: 10.1001/jamanetworkopen.2020.34208] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Preventing firearm violence requires understanding its antecedents. Yet no comprehensive longitudinal study has examined how involvement with firearms during adolescence-use, access, and victimization (defined as threatened with a weapon or gunshot injury)-is associated with the perpetration of firearm violence in adulthood. OBJECTIVE To examine the association between firearm involvement during adolescence and subsequent firearm perpetration and ownership in adulthood among youth involved in the juvenile justice system. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed interview responses of 1829 randomly selected participants as part of the Northwestern Juvenile Project, a longitudinal study of health needs and outcomes of youth sampled from a temporary juvenile detention center in a large US city. Youth aged 10 to 18 years were interviewed in detention from November 1995 through June 1998. Participants were reinterviewed up to 13 times over 16 years through February 2015, for a total of 17 776 interviews. The sample was stratified by sex, race/ethnicity, age, and legal status (juvenile or adult court). Data were analyzed from April 2017, when data preparation began, through November 2020. EXPOSURES Firearm involvement during adolescence: use (ie, threaten, shoot), access (ownership, ease of access, firearm in household, membership in gang that carries firearms), and victimization (gunshot injury, threatened with a weapon). MAIN OUTCOMES AND MEASURES Firearm involvement during adulthood: perpetration of firearm violence (ie, threatening with or using a firearm) and firearm ownership. RESULTS Among the 1829 participants, 1388 had a 16-year follow-up interview: 860 males, 528 females; 809 were African American, 203 were non-Hispanic White; 374 were Hispanic; and 2 were other race/ethnicity; median (interquartile range) age of 32 (30-32) years. Eighty-five percent of males and 63.2% of females were involved with firearms as adolescents. Compared with females, males had significantly higher odds of every type of involvement except having a firearm in the home. In adulthood, 41.3% of males and 10.5% of females perpetrated firearm violence. Adolescents who had been threatened with a weapon or injured by firearms had 3.1 (95% CI, 2.0-4.9) and 2.4 (95% CI, 1.2-4.9) times the odds of perpetrating violence during adulthood. Similar associations were found for firearm ownership. CONCLUSIONS AND RELEVANCE Involvement with firearms during adolescence-including victimization-is a significant risk factor for firearm perpetration and ownership during adulthood.
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Affiliation(s)
- Linda A. Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Medicine, Infectious Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Institute for Policy Research, Northwestern University, Evanston, Illinois
- Department of Sociology, Weinberg College of Arts & Sciences, Northwestern University, Evanston, Illinois
- School of Education and Public Policy, Northwestern University, Evanston, Illinois
| | - Nicholas S. Meyerson
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jessica A. Jakubowski
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David A. Aaby
- Department of Medicine, Infectious Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nanzi Zheng
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karen M. Abram
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leah J. Welty
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Zwecker NA, Harrison AJ, Welty LJ, Teplin LA, Abram KM. Social Support Networks among Delinquent Youth: An 8-Year Follow-up Study. J Offender Rehabil 2019; 57:459-480. [PMID: 31190722 PMCID: PMC6561504 DOI: 10.1080/10509674.2018.1523821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Supportive social networks are key to the successful transition to young adulthood. Yet, we know little about networks of delinquent youth, a population at risk for disrupted social connections. This study describes the structure and function of social support networks among delinquent youth eight years after detention; median age 24 years. Nearly one-fifth of participants had no one that they could count on, and one-third had only one person in their support network. Participants tended to have very dense networks composed almost entirely of family. Findings underscore the importance of expanding social supports for delinquent youth as they age.
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Affiliation(s)
- Naomi A. Zwecker
- OCD & Anxiety Program of Southern California, 2656 29th Street, Suite 208 Santa Monica, CA 90405
| | - Anna J. Harrison
- Zuckerberg San Francisco General Hospital and Trauma Center, Division of Infant, Child, and Adolescent Psychiatry, 1001 Potrero Avenue, Building 5, Suite 7G15, San Francisco, CA 94110
- University of California San Francisco, Department of Psychiatry, Weill Institute for Neurosciences
| | - Leah J. Welty
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Suite 900, Chicago IL, 60611
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Linda A. Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Suite 900, Chicago IL, 60611
| | - Karen M. Abram
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Suite 900, Chicago IL, 60611
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Abram KM, Azores-Gococo NM, Emanuel KM, Aaby DA, Welty LJ, Hershfield JA, Rosenbaum MS, Teplin LA. Sex and Racial/Ethnic Differences in Positive Outcomes in Delinquent Youth After Detention: A 12-Year Longitudinal Study. JAMA Pediatr 2017; 171:123-132. [PMID: 27992626 PMCID: PMC5704941 DOI: 10.1001/jamapediatrics.2016.3260] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Longitudinal studies of delinquent youth have focused on criminal recidivism, not on psychosocial outcomes in adulthood. This omission is critical because after detention most youth return to the community, where they become the responsibility of pediatric health care professionals. OBJECTIVE To investigate 8 positive outcomes among delinquent youth 5 and 12 years after detention, focusing on sex and racial/ethnic differences. DESIGN, SETTING, AND PARTICIPANTS In the Northwestern Juvenile Project, a longitudinal US study of long-term outcomes of delinquent youth after detention, participants were interviewed in detention between November 20, 1995, and June 14, 1998, and reinterviewed up to 9 times during the 12-year study period, through May 12, 2011. Data analysis was conducted between November 18, 2013, and July 25, 2016. EXPOSURES Juvenile detention. MAIN OUTCOMES AND MEASURES Achievement of positive outcomes in 8 domains: educational attainment, residential independence, gainful activity, desistance from criminal activity, mental health, abstaining from substance abuse, interpersonal functioning, and parenting responsibility. Outcomes were assessed with widely used measures supplemented by correctional records. RESULTS The study included 1829 youth at baseline (1172 males and 657 females; mean [SD] age, 14.9 [1.4] years). At the end of the study, 1520 (83.1%) of the original sample remained (944 males and 576 females; mean [SD] age, 27.6 [1.4] years). Twelve years after detention, females were more likely than males to have positive outcomes for gainful activity (odds ratio [OR], 2.53; 95% CI, 1.86-3.44), desistance from criminal activity (OR, 5.89; 95% CI, 4.38-7.92), residential independence (OR, 3.41; 95% CI, 2.57-4.52), parenting responsibility (OR, 18.65; 95% CI, 12.29-28.30), and mental health (OR, 1.48; 95% CI, 1.13-1.92). Twelve years after detention, only 21.9% of males and 54.7% of females had achieved more than half of the outcomes. As youth aged, the number of positive outcomes increased only modestly (mean increase for males, 0.37; 95% CI, 0.13-0.62; for females, 0.29; 95% CI, 0.13-0.45). Among males, non-Hispanic white individuals were significantly more likely to achieve most positive outcomes compared with minorities, but less likely to abstain from substance abuse. For example, 12 years after detention, non-Hispanic white males had nearly 3 times the odds of educational attainment compared with African American (OR, 2.82; 95% CI, 1.77-4.50) and Hispanic males (OR, 2.91; 95% CI, 1.75-4.82), and 2 to 5 times the odds of gainful activity compared with African American (OR, 5.17; 95% CI, 3.16-8.45) and Hispanic males (OR, 2.58; 95% CI, 1.56-4.26). Latent class analysis shows that African American males fared the worst, with lives characterized by incarceration, criminal activity, and few positive outcomes. CONCLUSIONS AND RELEVANCE Our findings highlight racial/ethnic disparities among youth in achieving positive outcomes after detention. To improve outcomes, pediatric health care professionals should recognize the importance of psychosocial health, partner with on-site psychosocial services in their practices, and facilitate access to services in the community.
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Affiliation(s)
- Karen M. Abram
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nicole M. Azores-Gococo
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kristin M. Emanuel
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David A. Aaby
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leah J. Welty
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jennifer A. Hershfield
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Melinda S. Rosenbaum
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Linda A. Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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Welty LJ, Hershfield JA, Abram KM, Han H, Byck GR, Teplin LA. Trajectories of Substance Use Disorder in Youth After Detention: A 12-Year Longitudinal Study. J Am Acad Child Adolesc Psychiatry 2017; 56:140-148. [PMID: 28117060 PMCID: PMC5308462 DOI: 10.1016/j.jaac.2016.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 10/20/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Leah J Welty
- Health Disparities and Public Policy, Northwestern University Feinberg School of Medicine, Chicago
| | - Jennifer A Hershfield
- Health Disparities and Public Policy, Northwestern University Feinberg School of Medicine, Chicago; Children's Hospital Los Angeles, University of Southern California Center for Excellence in Developmental Disabilities, Los Angeles
| | - Karen M Abram
- Health Disparities and Public Policy, Northwestern University Feinberg School of Medicine, Chicago
| | - Hongyun Han
- Health Disparities and Public Policy, Northwestern University Feinberg School of Medicine, Chicago
| | - Gayle R Byck
- Health Disparities and Public Policy, Northwestern University Feinberg School of Medicine, Chicago
| | - Linda A Teplin
- Health Disparities and Public Policy, Northwestern University Feinberg School of Medicine, Chicago.
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Abram KM, Stokes ML, Welty LJ, Aaby DA, Teplin LA. Disparities in HIV/AIDS Risk Behaviors After Youth Leave Detention: A 14-Year Longitudinal Study. Pediatrics 2017; 139:e20160360. [PMID: 28115541 PMCID: PMC5260145 DOI: 10.1542/peds.2016-0360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine changes in the prevalence of 15 HIV/AIDS sex and drug risk behaviors in delinquent youth during the 14 years after they leave detention, focusing on sex and racial/ethnic differences. METHODS The Northwestern Juvenile Project, a prospective longitudinal study of 1829 youth randomly sampled from detention in Chicago, Illinois, recruited between 1995 and 1998 and reinterviewed up to 11 times. Independent interviewers assessed HIV/AIDS risk behaviors using the National Institutes on Drug Abuse Risk Behavior Assessment. RESULTS Fourteen years after detention (median age, 30 years), one-quarter of males and one-tenth of females had >1 sexual partner in the past 3 months. One-tenth of participants reported recent unprotected vaginal sex with a high-risk partner. There were many sex and racial/ethnic differences. For example, African American males had 4.67 times the odds of having >1 partner than African American females (95% confidence interval [CI], 3.22-6.76). Over time, compared with non-Hispanic white males, African American males had 2.56 times the odds (95% CI, 1.97-3.33) and Hispanic males had 1.63 times the odds (95% CI, 1.24-2.12) of having multiple partners, even after adjusting for incarceration and age. Non-Hispanic white females were more likely to have multiple partners than racial/ethnic minority females. CONCLUSIONS Although rates decrease over time, prevalence of sex risk behaviors are much higher than the general population. Among males, racial/ethnic minorities were at particular risk. The challenge for pediatric health is to address how disproportionate confinement of racial/ethnic minority youth contributes to disparities in the HIV/AIDS epidemic.
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Affiliation(s)
- Karen M Abram
- Departments of Psychiatry and Behavioral Sciences, and
| | | | - Leah J Welty
- Departments of Psychiatry and Behavioral Sciences, and
- Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David A Aaby
- Departments of Psychiatry and Behavioral Sciences, and
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Abram KM. New Evidence for the Role of Mental Disorders in the Development of Substance Abuse. J Am Acad Child Adolesc Psychiatry 2016; 55:265-6. [PMID: 27015715 DOI: 10.1016/j.jaac.2016.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/19/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Karen M Abram
- Health Disparities and Public Policy program, Northwestern University Feinberg School of Medicine, Chicago.
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Stokes ML, McCoy KP, Abram KM, Byck GR, Teplin LA. Suicidal Ideation and Behavior in Youth in the Juvenile Justice System: A Review of the Literature. J Correct Health Care 2016; 21:222-42. [PMID: 26084946 DOI: 10.1177/1078345815587001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Suicide is prevalent among youth, especially those involved in the juvenile justice system. Although many studies have examined suicidal ideation and behavior in delinquent youth, prevalence rates vary widely. This article reviews studies of suicidal ideation and behavior in youth in the juvenile justice system, focusing on the point of contact: incarceration status and stage of judicial processing. Suicidal ideation and behavior are prevalent and increase with greater involvement in the juvenile justice system. Depression, sexual abuse, and trauma were the most commonly identified predictors of suicidal ideation and behavior. Prevalence rates of suicidal ideation and behavior vary by gender and race/ethnicity, indicating the need for gender-specific and culturally relevant interventions.
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Affiliation(s)
- Marquita L Stokes
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kathleen P McCoy
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen M Abram
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gayle R Byck
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Linda A Teplin
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Welty LJ, Harrison AJ, Abram KM, Olson ND, Aaby DA, McCoy KP, Washburn JJ, Teplin LA. Health Disparities in Drug- and Alcohol-Use Disorders: A 12-Year Longitudinal Study of Youths After Detention. Am J Public Health 2016; 106:872-80. [PMID: 26985602 DOI: 10.2105/ajph.2015.303032] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
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.
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Affiliation(s)
- Leah J Welty
- Linda A. Teplin, Anna J. Harrison, Karen M. Abram, Nichole D. Olson, David A. Aaby, and Kathleen P. McCoy are with Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Leah J. Welty is with Department of Preventive Medicine and Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Jason J. Washburn is with Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL
| | - Anna J Harrison
- Linda A. Teplin, Anna J. Harrison, Karen M. Abram, Nichole D. Olson, David A. Aaby, and Kathleen P. McCoy are with Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Leah J. Welty is with Department of Preventive Medicine and Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Jason J. Washburn is with Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL
| | - Karen M Abram
- Linda A. Teplin, Anna J. Harrison, Karen M. Abram, Nichole D. Olson, David A. Aaby, and Kathleen P. McCoy are with Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Leah J. Welty is with Department of Preventive Medicine and Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Jason J. Washburn is with Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL
| | - Nichole D Olson
- Linda A. Teplin, Anna J. Harrison, Karen M. Abram, Nichole D. Olson, David A. Aaby, and Kathleen P. McCoy are with Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Leah J. Welty is with Department of Preventive Medicine and Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Jason J. Washburn is with Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL
| | - David A Aaby
- Linda A. Teplin, Anna J. Harrison, Karen M. Abram, Nichole D. Olson, David A. Aaby, and Kathleen P. McCoy are with Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Leah J. Welty is with Department of Preventive Medicine and Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Jason J. Washburn is with Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL
| | - Kathleen P McCoy
- Linda A. Teplin, Anna J. Harrison, Karen M. Abram, Nichole D. Olson, David A. Aaby, and Kathleen P. McCoy are with Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Leah J. Welty is with Department of Preventive Medicine and Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Jason J. Washburn is with Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL
| | - Jason J Washburn
- Linda A. Teplin, Anna J. Harrison, Karen M. Abram, Nichole D. Olson, David A. Aaby, and Kathleen P. McCoy are with Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Leah J. Welty is with Department of Preventive Medicine and Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Jason J. Washburn is with Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL
| | - Linda A Teplin
- Linda A. Teplin, Anna J. Harrison, Karen M. Abram, Nichole D. Olson, David A. Aaby, and Kathleen P. McCoy are with Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Leah J. Welty is with Department of Preventive Medicine and Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Jason J. Washburn is with Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL
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Piselli M, Attademo L, Garinella R, Rella A, Antinarelli S, Tamantini A, Quartesan R, Stracci F, Abram KM. Psychiatric needs of male prison inmates in Italy. Int J Law Psychiatry 2015; 41:82-88. [PMID: 25888500 DOI: 10.1016/j.ijlp.2015.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This paper presents data on the mental health needs of men in an Italian prison and examines if mental health needs of inmates differ across key correctional subpopulations. Interviewers conducted semi-structured clinical interviews with 526 convicted males incarcerated in the Spoleto Prison from October 2010 through September 2011. Nearly two thirds (65.0%) of inmates had an Axis I or Axis II disorder. About half (52.7%) had an Axis I disorder. Personality disorders were the most common disorders (51.9%), followed by anxiety (25.3%) and substance use disorders (24.9%). Over one third of inmates (36.6%) had comorbid types of disorder. The most common comorbid types of disorders were substance use disorders plus personality disorders (20.1%) and anxiety disorders plus personality disorders (18.0%). Findings underscore a significant need for specialized mental health services for men in Italian prisons. Moreover, as inmates return to the community, their care becomes the responsibility of the community health system. Service systems must be equipped to provide integrated services for those with both psychiatric and substance use disorders and be prepared for challenges posed by patients with personality disorders.
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Affiliation(s)
- Massimiliano Piselli
- Functional Area of Psychiatry, University of Perugia, AUSL Umbria 2, Ospedale San Giovanni Battista, Servizio Psichiatrico Diagnosi e Cura, Via Massimo Arcamone, 06034 Foligno, Italy.
| | - Luigi Attademo
- School of Psychiatry, University of Perugia, Department of Medicine, Division of Psychiatry, Clinical Psychology and Psychiatric Rehabilitation, New Faculty of Medicine, Ellisse Edificio A Piano 8, Loc. Sant'Andrea delle Fratte, 06156 Perugia, Italy
| | - Raffaele Garinella
- School of Psychiatry, University of Perugia, Department of Medicine, Division of Psychiatry, Clinical Psychology and Psychiatric Rehabilitation, New Faculty of Medicine, Ellisse Edificio A Piano 8, Loc. Sant'Andrea delle Fratte, 06156 Perugia, Italy
| | - Angelo Rella
- Functional Area of Psychiatry, University of Perugia, AUSL Umbria 2, Ospedale San Giovanni Battista, Servizio Psichiatrico Diagnosi e Cura, Via Massimo Arcamone, 06034 Foligno, Italy
| | - Simonetta Antinarelli
- Health District of Spoleto, AUSL Umbria 2, Palazzina Micheli Piazza D. Perilli 1, 06049 Spoleto, Italy.
| | - Antonia Tamantini
- Functional Area of Psychiatry, University of Perugia, AUSL Umbria 2, Ospedale San Giovanni Battista, Servizio Psichiatrico Diagnosi e Cura, Via Massimo Arcamone, 06034 Foligno, Italy
| | - Roberto Quartesan
- School of Psychiatry, University of Perugia, Department of Medicine, Division of Psychiatry, Clinical Psychology and Psychiatric Rehabilitation, New Faculty of Medicine, Ellisse Edificio A Piano 8, Loc. Sant'Andrea delle Fratte, 06156 Perugia, Italy; Department of Medicine, Division of Psychiatry, Clinical Psychology and Psychiatric Rehabilitation, New Faculty of Medicine, University of Perugia, Ellisse Edificio A Piano 8, Loc. Sant'Andrea delle Fratte, 06156 Perugia, Italy.
| | - Fabrizio Stracci
- Department of Experimental Medicine, Umbrian Population Cancer Registry, Division of Public Health, University of Perugia, Via Del Giochetto, 06122 Perugia, Italy.
| | - Karen M Abram
- Department of Psychiatry and Behavioral Sciences, Health Disparities and Public Policy Program, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Suite 900, Chicago, IL 60611, USA.
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El Bcheraoui C, Zhang X, Welty LJ, Abram KM, Teplin LA, Sutton MY. HIV Knowledge Among a Longitudinal Cohort of Juvenile Detainees in an Urban Setting. J Correct Health Care 2015; 21:112-24. [PMID: 25788607 PMCID: PMC5704944 DOI: 10.1177/1078345815572596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors investigated HIV knowledge change among a cohort of juvenile detainees. Participants completed an HIV knowledge survey at baseline and up to 4 more times over 6 years. The authors calculated knowledge scores; the time serial trend of scores was modeled using generalized estimating equations. A baseline survey was completed by 798 participants, ages 14 to 18 years; mean HIV knowledge scores ranged from 11.4 to 14.1 (maximum score = 18). Males had significantly lower HIV knowledge scores than females at baseline only. Over time, Hispanic participants had significantly lower scores than non-Hispanic Black and non-Hispanic White participants. Overall, HIV knowledge increased but was still suboptimal 5 years after baseline. These findings suggest the need to develop and strengthen HIV prevention education programs in youth detention settings.
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Affiliation(s)
- Charbel El Bcheraoui
- Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education and Professional Development Program, Office of Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Xinjian Zhang
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Leah J Welty
- The Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA The Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Karen M Abram
- The Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Linda A Teplin
- The Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Madeline Y Sutton
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Elkington KS, Teplin LA, Abram KM, Jakubowski JA, Dulcan MK, Welty LJ. Psychiatric disorders and violence: a study of delinquent youth after detention. J Am Acad Child Adolesc Psychiatry 2015; 54:302-12.e5. [PMID: 25791147 PMCID: PMC4369770 DOI: 10.1016/j.jaac.2015.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 12/18/2014] [Accepted: 01/08/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the relationship between psychiatric disorders and violence in delinquent youth after detention. METHOD The Northwestern Juvenile Project is a longitudinal study of youth from the Cook County Juvenile Temporary Detention Center (Chicago, Illinois). Violence and psychiatric disorders were assessed via self-report in 1,659 youth (56% African American, 28% Hispanic, 36% female, aged 13-25 years) interviewed up to 4 times between 3 and 5 years after detention. Using generalized estimating equations and logistic regression, we examined the following: the prevalence of violence 3 and 5 years after detention; the contemporaneous relationships between psychiatric disorders and violence as youth age; and whether the presence of a psychiatric disorder predicts subsequent violence. RESULTS Rates of any violence decreased between 3 and 5 years after detention, from 35% to 21% (males), and from 20% to 17% (females). There was a contemporaneous relationship between disorder and violence. Compared to the group with no disorder, males and females with any disorder had greater odds of any violence (adjusted odds ratio [AOR] = 3.0, 95% CI = 1.9-4.7, and AOR = 4.4, 95% CI = 3.0-6.3, respectively). All specific disorders were associated contemporaneously with violence, except for major depressive disorder/dysthymia among males. Substance use disorders predicted subsequent violence. Males with other drug use disorder and females with marijuana use disorder 3 years after detention had greater odds of any violence 2 years later (AOR = 3.4, 95% CI = 1.4-8.2, and AOR = 2.0, 95% CI = 1.1-3.8, respectively). CONCLUSION Aside from substance use disorders, the psychiatric disorders studied may not be useful markers of subsequent violence. Violence assessment and reduction must be key components of ongoing psychiatric services for high-risk youth.
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Affiliation(s)
- Katherine S Elkington
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, and Columbia University, New York
| | - Linda A Teplin
- Northwestern University, Feinberg School of Medicine, Chicago.
| | - Karen M Abram
- Northwestern University, Feinberg School of Medicine, Chicago
| | | | - Mina K Dulcan
- Northwestern University, Feinberg School of Medicine, Chicago; Ann and Robert H. Lurie Children's Hospital of Chicago
| | - Leah J Welty
- Northwestern University, Feinberg School of Medicine, Chicago
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Abram KM, Zwecker NA, Welty LJ, Hershfield JA, Dulcan MK, Teplin LA. Comorbidity and continuity of psychiatric disorders in youth after detention: a prospective longitudinal study. JAMA Psychiatry 2015; 72:84-93. [PMID: 25426584 PMCID: PMC4562696 DOI: 10.1001/jamapsychiatry.2014.1375] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Psychiatric disorders and comorbidity are prevalent among incarcerated juveniles. To date, no large-scale study has examined the comorbidity and continuity of psychiatric disorders after youth leave detention. OBJECTIVE To determine the comorbidity and continuity of psychiatric disorders among youth 5 years after detention. DESIGN, SETTING, AND PARTICIPANTS Prospective longitudinal study of a stratified random sample of 1829 youth (1172 male and 657 female; 1005 African American, 296 non-Hispanic white, 524 Hispanic, and 4 other race/ethnicity) recruited from the Cook County Juvenile Temporary Detention Center, Chicago, Illinois, between November 20, 1995, and June 14, 1998, and who received their time 2 follow-up interview between May 22, 2000, and April 3, 2004. MAIN OUTCOMES AND MEASURES At baseline, the Diagnostic Interview Schedule for Children Version 2.3. At follow-ups, the Diagnostic Interview Schedule for Children Version IV (child and young adult versions) and the Diagnostic Interview Schedule Version IV (substance use disorders and antisocial personality disorder). RESULTS Five years after detention, when participants were 14 to 24 years old, almost 27% of males and 14% of females had comorbid psychiatric disorders. Although females had significantly higher rates of comorbidity when in detention (odds ratio, 1.3; 95% CI, 1.0-1.7), males had significantly higher rates than females at follow-up (odds ratio, 2.3; 95% CI, 1.6-3.3). Substance use plus behavioral disorders was the most common comorbid profile among males, affecting 1 in 6. Participants with more disorders at baseline were more likely to have a disorder approximately 5 years after detention, even after adjusting for demographic characteristics. We found substantial continuity of disorder. However, some baseline disorders predicted alcohol and drug use disorders at follow-up. CONCLUSIONS AND RELEVANCE Although prevalence rates of comorbidity decreased in youth after detention, rates remained substantial and were higher than rates in the most comparable studies of the general population. Youth with multiple disorders at baseline are at highest risk for disorder 5 years later. Because many psychiatric disorders first appear in childhood and adolescence, primary and secondary prevention of psychiatric disorders offers the greatest opportunity to reduce costs to individuals, families, and society. Only a concerted effort to address the many needs of delinquent youth will help them thrive in adulthood.
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Affiliation(s)
- Karen M Abram
- Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Leah J Welty
- Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois3Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago
| | - Jennifer A Hershfield
- Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mina K Dulcan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Linda A Teplin
- Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Lansing AE, Washburn JJ, Abram KM, Thomas UC, Welty LJ, Teplin LA. Cognitive and academic functioning of juvenile detainees: implications for correctional populations and public health. J Correct Health Care 2014; 20:18-30. [PMID: 24352405 DOI: 10.1177/1078345813505450] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cognitive functioning affects health. This study assessed cognitive functioning among participants in the Northwestern Juvenile Project, a stratified random sample of 1,829 newly detained juveniles (10 to 18 years old) from Cook County, Illinois. The study examined receptive vocabulary, oral reading, arithmetic computation skills, and general intellectual abilities. The sample exhibited impaired overall intellectual functioning and deficits in all areas. Males performed more poorly than females. More than three quarters of males showed below average overall intellectual functioning, and 9 in 10 had below average receptive vocabulary skills. Hispanic and African American males performed more poorly than non-Hispanic White males. The multiple systems that serve delinquent youth--correctional, health, legal, and rehabilitative--must collaborate to tailor needed services to the cognitive level of youth in the juvenile justice system.
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Affiliation(s)
- Amy E Lansing
- 1Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
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Teplin LA, Jakubowski JA, Abram KM, Olson ND, Stokes ML, Welty LJ. Firearm homicide and other causes of death in delinquents: a 16-year prospective study. Pediatrics 2014; 134:63-73. [PMID: 24936005 PMCID: PMC4067641 DOI: 10.1542/peds.2013-3966] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Delinquent youth are at risk for early violent death after release from detention. However, few studies have examined risk factors for mortality. Previous investigations studied only serious offenders (a fraction of the juvenile justice population) and provided little data on females. METHODS The Northwestern Juvenile Project is a prospective longitudinal study of health needs and outcomes of a stratified random sample of 1829 youth (657 females, 1172 males; 524 Hispanic, 1005 African American, 296 non-Hispanic white, 4 other race/ethnicity) detained between 1995 and 1998. Data on risk factors were drawn from interviews; death records were obtained up to 16 years after detention. We compared all-cause mortality rates and causes of death with those of the general population. Survival analyses were used to examine risk factors for mortality after youth leave detention. RESULTS Delinquent youth have higher mortality rates than the general population to age 29 years (P < .05), irrespective of gender or race/ethnicity. Females died at nearly 5 times the general population rate (P < .05); Hispanic males and females died at 5 and 9 times the general population rates, respectively (P < .05). Compared with the general population, significantly more delinquent youth died of homicide and its subcategory, homicide by firearm (P < .05). Among delinquent youth, racial/ethnic minorities were at increased risk of homicide compared with non-Hispanic whites (P < .05). Significant risk factors for external-cause mortality and homicide included drug dealing (up to 9 years later), alcohol use disorder, and gang membership (up to a decade later). CONCLUSIONS Delinquent youth are an identifiable target population to reduce disparities in early violent death.
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Affiliation(s)
| | | | - Karen M Abram
- Departments of Psychiatry and Behavioral Sciences, and
| | | | | | - Leah J Welty
- Departments of Psychiatry and Behavioral Sciences, andPreventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Teplin LA, Welty LJ, Abram KM, Dulcan MK, Washburn JJ. Prevalence and persistence of psychiatric disorders in youth after detention: a prospective longitudinal study. Arch Gen Psychiatry 2012; 69:1031-43. [PMID: 23026953 PMCID: PMC3737771 DOI: 10.1001/archgenpsychiatry.2011.2062] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Psychiatric disorders are prevalent among incarcerated juveniles. Most juveniles eventually return to their communities, where they become the responsibility of the community mental health system. However, no large-scale study has examined psychiatric disorders after youth leave detention. OBJECTIVE To examine changes in the prevalence and persistence of psychiatric disorders during the 5 years after detention, focusing on sex and racial/ethnic differences. DESIGN Prospective longitudinal study with up to 5 interviews (1829 youth: 1172 males and 657 females). To ensure representation of key demographic subgroups, the randomly selected sample was stratified by sex, race/ethnicity (African American, non-Hispanic white, and Hispanic), age, and legal status (juvenile or adult court). SETTING The Northwestern Juvenile Project, sampling youth from the Cook County Juvenile Temporary Detention Center, Chicago, Illinois. PARTICIPANTS Detained youth, aged 10 to 18 years at baseline interview. MAIN OUTCOME MEASURES At baseline, the Diagnostic Interview Schedule for Children Version 2.3. At follow-up interviews, the Diagnostic Interview Schedule for Children Version IV (Child and Young Adult versions) and the Diagnostic Interview Schedule Version IV (substance use disorders and antisocial personality disorder). RESULTS Five years after baseline, more than 45% of males and nearly 30% of females had 1 or more psychiatric disorders with associated impairment. More than 50% of males and more than 40% of females had 1 or more psychiatric disorders without impairment. Substance use disorders were the most common; males, however, had higher rates over time (5 years after baseline, adjusted odds ratio [AOR], 2.61; 95% CI, 1.96-3.47). Non-Hispanic whites and Hispanics also had higher rates of substance use disorders vs African Americans (AOR, 1.96; 95% CI, 1.54-2.49 and AOR, 1.59; 95% CI, 1.24-2.03). Females had higher rates of major depression over time (AOR, 1.59; 95% CI, 1.22-2.08). CONCLUSIONS Although prevalence rates of most psychiatric disorders declined as youth aged, a substantial proportion of delinquent youth continue to have disorders. There are notable sex and racial/ethnic differences in the prevalence and persistence of psychiatric disorders in this population.
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Affiliation(s)
- Linda A Teplin
- Health Disparities and Public Policy, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Abstract
OBJECTIVE This study examined the prevalence of childhood maltreatment and its relationship with current psychiatric disorders among detained youths. METHODS Clinical research interviewers assessed history of childhood maltreatment with the Child Maltreatment Assessment Profile and psychiatric diagnosis with the Diagnostic Interview Schedule for Children, version 2.3, in a stratified, random sample of 1,829 youths detained at the Cook Country Juvenile Temporary Detention Center (final sample, N=1,735). History of maltreatment was also ascertained from Cook County Court Child Protection Division records. RESULTS More than three-quarters of females and more than two-thirds of males had a history of physical abuse (moderate or severe). More than 40% of females and 10% of males had a history of sexual abuse. Females and non-Hispanic whites had the highest prevalence rates of childhood maltreatment. Among females, sexual abuse was associated with every type of psychiatric disorder. Females who experienced various types of abuse were 2.6 to 10.7 times as likely as females with no maltreatment to have any disorder. Among males, maltreatment was associated with every disorder except anxiety disorders (range of odds ratios, 1.9-7.9). Among youths who were sexually abused, abuse with force was associated with anxiety and affective disorders among females and attention-deficit hyperactivity or disruptive behavior disorders and substance use disorders among males. CONCLUSIONS Childhood maltreatment is common among detained youths and is also highly associated with psychiatric disorders. The mental health, child welfare, and juvenile justice systems must collaborate to ensure that youths receive protection and care when they return to their communities.
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Affiliation(s)
- Devon C King
- Centerfor Professional Psychology, George Washington University, Washington, DC, USA
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Abram KM, Choe JY, Washburn JJ, Romero EG, Teplin LA. Functional impairment in youth three years after detention. J Adolesc Health 2009; 44:528-35. [PMID: 19465316 PMCID: PMC2759315 DOI: 10.1016/j.jadohealth.2008.10.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 10/03/2008] [Accepted: 10/08/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE This article examines functional impairment across global and specific dimensions among youth 3 years after their detention. METHODS Functional impairment was assessed using the Child and Adolescent Functional Assessment Scale (CAFAS) in a large, stratified, random sample of formerly detained youth (N = 1653). RESULTS More than one-fifth of the individuals in the sample were scored as having marked impairment that required, at minimum, "multiple sources of care" (CAFAS Total Score of > or =100); 7.0% required "intensive intervention" (CAFAS Total Score > or =140). Most of the sample had impairment; only 7.5% had "no noteworthy impairment" (CAFAS Total Score < or =10). Significantly more males were impaired than females. Among males living in the community at follow-up, African Americans and Hispanics were more likely to be impaired than non-Hispanic whites. In comparison to males living in the community, males who were incarcerated at follow-up were significantly more likely to have impaired thinking and impaired functioning at home (if incarcerated, "home" is the correctional facility) but less likely to have substance use problems. CONCLUSIONS Three years after detention, most youth struggle in one or more life domains; more than one in five have marked impairment in functioning. These findings underscore the ongoing costs, to both youth and society, of our failure to provide effective rehabilitation to youth after detention.
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Affiliation(s)
- Karen M. Abram
- Psycho-Legal, Studies Program, Department of Psychiatry and Behavioral Sciences, Northwestern, University Feinberg School of Medicine, Chicago, IL
| | - Jeanne Y. Choe
- Psycho-Legal, Studies Program, Department of Psychiatry and Behavioral Sciences, Northwestern, University Feinberg School of Medicine, Chicago, IL
| | - Jason J. Washburn
- Psycho-Legal, Studies Program, Department of Psychiatry and Behavioral Sciences, Northwestern, University Feinberg School of Medicine, Chicago, IL, Alexian, Brothers Behavioral Health Hospital, Hoffman Estates, IL
| | - Erin G. Romero
- Psycho-Legal, Studies Program, Department of Psychiatry and Behavioral Sciences, Northwestern, University Feinberg School of Medicine, Chicago, IL
| | - Linda A. Teplin
- Psycho-Legal, Studies Program, Department of Psychiatry and Behavioral Sciences, Northwestern, University Feinberg School of Medicine, Chicago, IL
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Piselli M, Elisei S, Murgia N, Quartesan R, Abram KM. Co-occurring psychiatric and substance use disorders among male detainees in Italy. Int J Law Psychiatry 2009; 32:101-107. [PMID: 19237198 DOI: 10.1016/j.ijlp.2009.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This paper presents data on the prevalence of co-occurring substance use and psychiatric disorders among newly imprisoned males in Italy. Interviewers conducted semi-structured clinical interviews with n=302 male detainees seven days after their admission to the prison of Perugia from August 2005 through July 2006. Over half of male detainees (54.3%) had either a substance use disorder or another psychiatric disorder. One of every five detainees (20.9%) had comorbid substance use and psychiatric disorders. Compared to detainees with psychiatric disorder only, substance use disorder only, or no disorder, detainees with comorbid substance use and psychiatric disorders were significantly more likely to have severe impairment in the areas of employment, substance abuse, family and social functioning, and psychiatric symptoms. Findings underscore the need for careful diagnostic screening at intake, access to treatment during detention, and an effective transition to services at the time of release.
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Washburn JJ, Teplin LA, Voss LS, Simon CD, Abram KM, McClelland GM. Psychiatric disorders among detained youths: a comparison of youths processed in juvenile court and adult criminal court. Psychiatr Serv 2008; 59:965-73. [PMID: 18757588 PMCID: PMC2718561 DOI: 10.1176/ps.2008.59.9.965] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE All 50 states and the District of Columbia have legal mechanisms to try juveniles as adults in criminal court. This study examined the prevalence of psychiatric disorders among youths transferred to adult criminal court and youths processed in the juvenile court. METHODS Participants were a stratified random sample of 1,829 youths, ten to 18 years of age, who were arrested and detained in Chicago. Data from version 2.3 of the Diagnostic Interview Schedule for Children are presented for 1,715 youths, 13 to 18 years of age, including 1,440 youths processed in juvenile court and 275 youths processed in adult criminal court. RESULTS Males, African Americans, Hispanics, and older youths had greater odds of being processed in adult criminal court than females, non-Hispanic whites, and younger youths, even after the analyses controlled for felony-level violent crime. Among youths processed in adult criminal court, 68% had at least one psychiatric disorder and 43% had two or more types of disorders. Prevalence rates and the number of comorbid types of disorders were not significantly different between youths processed in adult criminal court and those processed in juvenile court. Among youths processed in adult criminal court, those sentenced to prison had significantly greater odds than those receiving a less severe sentence of having a disruptive behavior disorder, a substance use disorder, or comorbid affective and anxiety disorders. CONCLUSIONS Community and correctional systems must be prepared to provide psychiatric services to youths transferred to adult criminal court and especially to youths sentenced to prison. When developing and implementing services, psychiatric service providers must also consider the disproportionate representation of individuals from racial-ethnic minority groups in the transfer process.
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Affiliation(s)
- Jason J Washburn
- Department of Psychiatry and Behavioral Sciences, Psycho-Legal Studies Program, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Dr., Suite 900, Chicago, IL 60611, USA.
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Elkington KS, Teplin LA, Mericle AA, Welty LJ, Romero EG, Abram KM. HIV/sexually transmitted infection risk behaviors in delinquent youth with psychiatric disorders: a longitudinal study. J Am Acad Child Adolesc Psychiatry 2008; 47:901-11. [PMID: 18645421 PMCID: PMC2754224 DOI: 10.1097/chi.0b013e318179962b] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the prevalence and persistence of 20 human immunodeficiency virus (HIV)/sexually transmitted infection (STI) sexual and drug use risk behaviors and to predict their occurrence in four mutually exclusive diagnostic groups of delinquent youths: major mental disorder (MMD), substance use disorder (SUD), comorbid MMD and SUD (MMD+SUD), and neither disorder. METHOD At the baseline interview, HIV/STI risk behaviors were assessed in 800 juvenile detainees, ages 10 to 18 years; youths were reinterviewed approximately 3 years later. The final sample (N = 689) includes 298 females and 391 males. RESULTS The prevalence and persistence of HIV/STI risk behaviors were high in all of the diagnostic groups. Youths with an SUD at baseline were greater than 10 times more likely to be sexually active and to have vaginal sex at follow-up than youths with MMD+SUD (adjusted odds ratio [AOR] 10.86, 95% confidence interval [CI] 1.43-82.32; AOR 11.63, 95% CI 1.49-90.89, respectively) and four times more likely to be sexually active and to have vaginal sex than youths with neither disorder (AOR 4.20, 95% CI 1.06-16.62; AOR 4.73, 95% CI 1.21-18.50, respectively). Youths with an MMD at baseline were less likely to have engaged in unprotected vaginal and oral sex at follow-up compared with youths with neither disorder (AOR0.11, 95% CI 0.02-0.50; AOR 0.07, 95% CI 0.01-0.34, respectively), and with youths with an SUD (AOR 0.10, 95% CI 0.02-0.50; AOR 0.10, 95% CI 0.02-0.47, respectively). Youths with MMD+SUD were less likely (AOR 0.28, 95% CI 0.09-0.92) to engage in unprotected oral sex compared with those with neither disorder. CONCLUSIONS Irrespective of diagnostic group, delinquent youths are at great risk for HIV/STIs as they enter into adulthood. SUD increases risk. Because detained youths are released after approximately 2 weeks, their risk behaviors become a community health problem. Pediatricians and child and adolescent psychiatrists must collaborate with corrections professionals to develop HIV/STI interventions and ensure that programs started in detention centers continue after youths are released.
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Affiliation(s)
- Katherine S Elkington
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, USA
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Choe JY, Teplin LA, Abram KM. Perpetration of violence, violent victimization, and severe mental illness: balancing public health concerns. Psychiatr Serv 2008. [PMID: 18245157 DOI: 10.1176/appi.ps.59.2.153] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This review examined U.S. empirical studies published since 1990 of the perpetration of violence and of violent victimization among persons with severe mental illness and their relative importance as public health concerns. METHODS MEDLINE, PsycINFO, and Web of Science were searched for published empirical investigations of recent prevalence or incidence of perpetration or victimization among persons with severe mental illness. Studies of special populations were included if separate rates were reported for persons with and without severe mental illness. RESULTS The search yielded 31 studies of violence perpetration and ten studies of violent victimization. Few examined perpetration and victimization in the same sample. Prevalence rates varied by sample type and time frame (recall period). Half of the studies of perpetration examined inpatients; of these, about half sampled only committed inpatients, whose rates of perpetration (17%-50%) were higher than those of other samples. Among outpatients, 2% to 13% had perpetrated violence in the past six months to three years, compared with 20% to 34% who had been violently victimized. Studies combining outpatients and inpatients reported that 12% to 22% had perpetrated violence in the past six to 18 months, compared with 35% who had been a victim in the past year. CONCLUSIONS Perpetration of violence and violent victimization are more common among persons with severe mental illness than in the general population. Victimization is a greater public health concern than perpetration. Ironically, the discipline's focus on perpetration among inpatients may contribute to negative stereotypes.
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Affiliation(s)
- Jeanne Y Choe
- Psycho-Legal Studies Program, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Abstract
OBJECTIVE To examine suicidal ideation, suicide attempts, lethality of suicide attempts, and the relationship between psychiatric disorder and recent attempts in newly detained juveniles. METHOD The sample included 1,829 juveniles, ages 10 to 18 years, sampled after intake to a detention center in Chicago. Interviewers administered the Diagnostic Interview Schedule for Children to assess for thoughts of death, suicidal ideation, suicide plans, lifetime suicide attempts, number of attempts, age at first attempt, attempts within the past 6 months, method of suicide attempts, and psychiatric disorder. RESULTS More than one third of juvenile detainees and nearly half of females had felt hopeless or thought about death in the 6 months before detention. Approximately 1 in 10 (10.3%, 95% confidence interval: 7.7%-12.8%) juvenile detainees had thought about committing suicide in the past 6 months, and 1 in 10 (11.0%, 95% confidence interval: 8.3%-13.7%) had ever attempted suicide. Recent suicide attempts were most prevalent in females and youths with major depression and generalized anxiety disorder. CONCLUSIONS Fewer than half of detainees with recent thoughts of suicide had told anyone about their ideation. Identifying youths at risk for suicide, especially those suffering from depressive and anxiety disorders, is a crucial step in preventing suicide.
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Affiliation(s)
- Karen M Abram
- Drs. Abram, Washburn, Teplin, and Dulcan and Ms. Choe are with the Department of Psychiatry and Behavioral Sciences, Psycho-Legal Studies Program, Northwestern University Feinberg School of Medicine; Dr. King is a contractor with NIMH..
| | - Jeanne Y Choe
- Drs. Abram, Washburn, Teplin, and Dulcan and Ms. Choe are with the Department of Psychiatry and Behavioral Sciences, Psycho-Legal Studies Program, Northwestern University Feinberg School of Medicine; Dr. King is a contractor with NIMH
| | - Jason J Washburn
- Drs. Abram, Washburn, Teplin, and Dulcan and Ms. Choe are with the Department of Psychiatry and Behavioral Sciences, Psycho-Legal Studies Program, Northwestern University Feinberg School of Medicine; Dr. King is a contractor with NIMH
| | - Linda A Teplin
- Drs. Abram, Washburn, Teplin, and Dulcan and Ms. Choe are with the Department of Psychiatry and Behavioral Sciences, Psycho-Legal Studies Program, Northwestern University Feinberg School of Medicine; Dr. King is a contractor with NIMH
| | - Devon C King
- Drs. Abram, Washburn, Teplin, and Dulcan and Ms. Choe are with the Department of Psychiatry and Behavioral Sciences, Psycho-Legal Studies Program, Northwestern University Feinberg School of Medicine; Dr. King is a contractor with NIMH
| | - Mina K Dulcan
- Drs. Abram, Washburn, Teplin, and Dulcan and Ms. Choe are with the Department of Psychiatry and Behavioral Sciences, Psycho-Legal Studies Program, Northwestern University Feinberg School of Medicine; Dr. King is a contractor with NIMH
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Abstract
OBJECTIVE This review examined U.S. empirical studies published since 1990 of the perpetration of violence and of violent victimization among persons with severe mental illness and their relative importance as public health concerns. METHODS MEDLINE, PsycINFO, and Web of Science were searched for published empirical investigations of recent prevalence or incidence of perpetration or victimization among persons with severe mental illness. Studies of special populations were included if separate rates were reported for persons with and without severe mental illness. RESULTS The search yielded 31 studies of violence perpetration and ten studies of violent victimization. Few examined perpetration and victimization in the same sample. Prevalence rates varied by sample type and time frame (recall period). Half of the studies of perpetration examined inpatients; of these, about half sampled only committed inpatients, whose rates of perpetration (17%-50%) were higher than those of other samples. Among outpatients, 2% to 13% had perpetrated violence in the past six months to three years, compared with 20% to 34% who had been violently victimized. Studies combining outpatients and inpatients reported that 12% to 22% had perpetrated violence in the past six to 18 months, compared with 35% who had been a victim in the past year. CONCLUSIONS Perpetration of violence and violent victimization are more common among persons with severe mental illness than in the general population. Victimization is a greater public health concern than perpetration. Ironically, the discipline's focus on perpetration among inpatients may contribute to negative stereotypes.
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Affiliation(s)
- Jeanne Y Choe
- Psycho-Legal Studies Program, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Abram KM, Washburn JJ, Teplin LA, Emanuel KM, Romero EG, McClelland GM. Posttraumatic stress disorder and psychiatric comorbidity among detained youths. Psychiatr Serv 2008. [PMID: 17914008 DOI: 10.1176/appi.ps.58.10.1311] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study examined the prevalence of posttraumatic stress disorder (PTSD) and comorbid psychiatric disorders among juvenile detainees. METHODS The sample consisted of a stratified random sample of 898 youths aged ten to 18 years who were arrested and detained in Chicago. RESULTS Among participants with PTSD, 93% had at least one comorbid psychiatric disorder; however, among those without PTSD, 64% had at least one comorbid psychiatric disorder. Over half (54%) of the participants with PTSD had two or more types of comorbid disorders--that is, affective, anxiety, behavioral, or substance use disorders--and 11% had all four types of comorbid disorders. Among males, having any psychiatric diagnosis significantly increased the odds of having comorbid PTSD. Among females, alcohol use disorder and both alcohol and drug use disorders significantly increased the odds of having PTSD. No significant difference in prevalence rates of PTSD was found between males and females with specific psychiatric disorders. The prevalence of any comorbid psychiatric disorder was significantly greater for males with PTSD than that for females with PTSD (OR=3.4, CI=1.1-10.6, p<.05). CONCLUSIONS Detection of comorbid PTSD among detained youths must be improved. PTSD is often missed because traumatic experiences are rarely included in standard screens or volunteered by patients. When planning treatment, clinicians must consider ramifications of comorbid PTSD.
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Affiliation(s)
- Karen M Abram
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Dr., Suite 900, Chicago, IL 60611, USA.
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Abstract
OBJECTIVE This study examined the prevalence of posttraumatic stress disorder (PTSD) and comorbid psychiatric disorders among juvenile detainees. METHODS The sample consisted of a stratified random sample of 898 youths aged ten to 18 years who were arrested and detained in Chicago. RESULTS Among participants with PTSD, 93% had at least one comorbid psychiatric disorder; however, among those without PTSD, 64% had at least one comorbid psychiatric disorder. Over half (54%) of the participants with PTSD had two or more types of comorbid disorders--that is, affective, anxiety, behavioral, or substance use disorders--and 11% had all four types of comorbid disorders. Among males, having any psychiatric diagnosis significantly increased the odds of having comorbid PTSD. Among females, alcohol use disorder and both alcohol and drug use disorders significantly increased the odds of having PTSD. No significant difference in prevalence rates of PTSD was found between males and females with specific psychiatric disorders. The prevalence of any comorbid psychiatric disorder was significantly greater for males with PTSD than that for females with PTSD (OR=3.4, CI=1.1-10.6, p<.05). CONCLUSIONS Detection of comorbid PTSD among detained youths must be improved. PTSD is often missed because traumatic experiences are rarely included in standard screens or volunteered by patients. When planning treatment, clinicians must consider ramifications of comorbid PTSD.
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Affiliation(s)
- Karen M Abram
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Dr., Suite 900, Chicago, IL 60611, USA.
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Romero EG, Teplin LA, McClelland GM, Abram KM, Welty LJ, Washburn JJ. A longitudinal study of the prevalence, development, and persistence of HIV/sexually transmitted infection risk behaviors in delinquent youth: implications for health care in the community. Pediatrics 2007. [PMID: 17473083 DOI: 10.1542/peds.2006–0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Our goal was to examine the prevalence, development, and persistence of drug and sex risk behaviors that place delinquent youth at risk for HIV and other sexually transmitted infections. METHODS At the baseline interview, HIV/sexually transmitted infection drug and sex risk behaviors were assessed in a stratified random sample of 800 juvenile detainees aged 10 to 18 years. Participants were reinterviewed approximately 3 years later. The final sample in these analyses (n = 724) included 316 females and 408 males; there were 393 African American participants, 198 Hispanic participants, 131 non-Hispanic white participants, and 2 participants who self-identified their race as "other." RESULTS More than 60% of youth had engaged in > or = 10 risk behaviors at their baseline interview, and nearly two thirds of them persisted in > or = 10 risk behaviors at follow-up. Among youth living in the community, many behaviors were more prevalent at follow-up than at baseline. Among incarcerated youth, the opposite pattern prevailed. Compared with females, males had higher prevalence rates of many HIV/sexually transmitted infection risk behaviors and were more likely to persist in some behaviors and develop new ones. Yet, injection risk behaviors were more prevalent among females than males and were also more likely to develop and persist. Overall, there were few racial and ethnic differences in patterns of HIV/sexually transmitted infection risk behaviors; most involved the initiation and persistence of substance use among non-Hispanic whites and Hispanics. CONCLUSIONS Because detained youth have a median stay of only 2 weeks, HIV/sexually transmitted infection risk behaviors in delinquent youth are a community public health problem, not just a problem for the juvenile justice system. Improving the coordination among systems that provide HIV/sexually transmitted infection interventions to youth--primary care, education, mental health, and juvenile justice--can reduce the prevalence of risk behaviors and substantially reduce the spread of HIV/sexually transmitted infection in young people.
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Affiliation(s)
- Erin Gregory Romero
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 710 N Lakeshore Dr, Chicago, IL 60611, USA
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Romero EG, Teplin LA, McClelland GM, Abram KM, Welty LJ, Washburn JJ. A longitudinal study of the prevalence, development, and persistence of HIV/sexually transmitted infection risk behaviors in delinquent youth: implications for health care in the community. Pediatrics 2007; 119:e1126-41. [PMID: 17473083 PMCID: PMC2813809 DOI: 10.1542/peds.2006-0128] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Our goal was to examine the prevalence, development, and persistence of drug and sex risk behaviors that place delinquent youth at risk for HIV and other sexually transmitted infections. METHODS At the baseline interview, HIV/sexually transmitted infection drug and sex risk behaviors were assessed in a stratified random sample of 800 juvenile detainees aged 10 to 18 years. Participants were reinterviewed approximately 3 years later. The final sample in these analyses (n = 724) included 316 females and 408 males; there were 393 African American participants, 198 Hispanic participants, 131 non-Hispanic white participants, and 2 participants who self-identified their race as "other." RESULTS More than 60% of youth had engaged in > or = 10 risk behaviors at their baseline interview, and nearly two thirds of them persisted in > or = 10 risk behaviors at follow-up. Among youth living in the community, many behaviors were more prevalent at follow-up than at baseline. Among incarcerated youth, the opposite pattern prevailed. Compared with females, males had higher prevalence rates of many HIV/sexually transmitted infection risk behaviors and were more likely to persist in some behaviors and develop new ones. Yet, injection risk behaviors were more prevalent among females than males and were also more likely to develop and persist. Overall, there were few racial and ethnic differences in patterns of HIV/sexually transmitted infection risk behaviors; most involved the initiation and persistence of substance use among non-Hispanic whites and Hispanics. CONCLUSIONS Because detained youth have a median stay of only 2 weeks, HIV/sexually transmitted infection risk behaviors in delinquent youth are a community public health problem, not just a problem for the juvenile justice system. Improving the coordination among systems that provide HIV/sexually transmitted infection interventions to youth--primary care, education, mental health, and juvenile justice--can reduce the prevalence of risk behaviors and substantially reduce the spread of HIV/sexually transmitted infection in young people.
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Affiliation(s)
- Erin Gregory Romero
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University Chicago, IL
| | - Linda A. Teplin
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University Chicago, IL
| | - Gary M. McClelland
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University Chicago, IL
| | - Karen M. Abram
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University Chicago, IL
| | - Leah J. Welty
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University Chicago, IL
| | - Jason J. Washburn
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University Chicago, IL
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Washburn JJ, Romero EG, Welty LJ, Abram KM, Teplin LA, McClelland GM, Paskar LD. Development of antisocial personality disorder in detained youths: the predictive value of mental disorders. J Consult Clin Psychol 2007; 75:221-31. [PMID: 17469880 PMCID: PMC2804474 DOI: 10.1037/0022-006x.75.2.221] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Antisocial personality disorder (APD) is a serious public and mental health concern. Understanding how well conduct disorder (CD) and other mental disorders predict the development of APD among youths involved in the juvenile justice system is critical for prevention. The authors used a stratified random sample of 1,112 detained youths to examine the development of APD at a 3-year follow-up interview. Nearly one fifth of male juvenile detainees later developed APD; approximately one quarter of male juvenile detainees with CD at baseline later developed APD. Significantly more males than females developed APD; no differences were found by race/ethnicity. Having 5 or more symptoms of CD, dysthymia, alcohol use disorder, or generalized anxiety disorder was significantly associated with developing modified APD (M-APD; APD without the CD requirement). Some disorders were strong predictors of APD; however, none were adequate screeners for identifying which detainees would later develop M-APD. The findings of this study have implications for interventions and further research in developmental psychopathology.
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Affiliation(s)
- Jason J Washburn
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Swahn MH, Whitaker DJ, Pippen CB, Leeb RT, Teplin LA, Abram KM, McClelland GM. Concordance between self-reported maltreatment and court records of abuse or neglect among high-risk youths. Am J Public Health 2006; 96:1849-53. [PMID: 17008582 PMCID: PMC1586157 DOI: 10.2105/ajph.2004.058230] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the concordance between measures of self-reported maltreatment and court records of abuse or neglect in a sample of detained youths. METHODS Data were collected by the Northwestern Juvenile Project and include interviews from 1829 youths aged 10-18 years. Participants were newly detained youths in the Cook County Juvenile Temporary Detention Center in Illinois between 1995 and 1998. Self-reported cases of child maltreatment were compared with court records of abuse or neglect in the Cook County judicial system. RESULTS We found that among detained youths, 16.6% of those who reported any maltreatment, 22.2% of those who reported the highest level of maltreatment, and 25.1% of those who reported that they required medical treatment as a result of maltreatment had a court record of abuse or neglect. Among those with any self-reported maltreatment, girls (vs boys) and African Americans (vs Whites) were more likely to have a court record (adjusted odds ratio [AOR]=2.18; 95% confidence interval [CI]=1.53, 3.09; and AOR=2.12; 95% CI=1.23, 3.63, respectively). CONCLUSIONS Official records seriously underestimate the prevalence of maltreatment, which indicates that multiple data sources are needed to document the true prevalence of maltreatment.
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Affiliation(s)
- Monica H Swahn
- Office on Smoking and Health, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Ga 30341-3724, USA.
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Teplin LA, Abram KM, McClelland GM, Washburn JJ, Pikus AK. Detecting mental disorder in juvenile detainees: who receives services. Am J Public Health 2005; 95:1773-80. [PMID: 16186454 PMCID: PMC1449435 DOI: 10.2105/ajph.2005.067819] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2005] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined whether or not juvenile detainees with major mental disorders received treatment, and the variables that predicted who received services. METHODS Our sample was 1829 randomly selected juvenile detainees taking part in the Northwestern Juvenile Project. To determine need for mental health services, independent interviewers administered the Diagnostic Interview Schedule for Children and rated functional impairment using the Child Global Assessment Scale. Records on service provision were obtained from the juvenile justice and public health systems. RESULTS Among detainees who had major mental disorders and associated functional impairments, 15.4% received treatment in the detention center and 8.1% received treatment in the community by the time of case disposition or 6 months, whichever came first. Significantly more girls than boys were detected and treated. Receiving treatment was predicted by clinical variables (having a major mental disorder or reported treatment history or suicidal behavior) and demographic variables. CONCLUSIONS The challenge to public health is to provide accessible, innovative, and effective treatments to juvenile detainees, a population that is often beyond the reach of traditional services.
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Affiliation(s)
- Linda A Teplin
- Psycho-Legal Studies Program, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Suite 900, Chicago, IL 60611-3078, USA.
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Teplin LA, McClelland GM, Abram KM, Weiner DA. Crime victimization in adults with severe mental illness: comparison with the National Crime Victimization Survey. ACTA ACUST UNITED AC 2005; 62:911-21. [PMID: 16061769 PMCID: PMC1389236 DOI: 10.1001/archpsyc.62.8.911] [Citation(s) in RCA: 244] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Since deinstitutionalization, most persons with severe mental illness (SMI) now live in the community, where they are at great risk for crime victimization. OBJECTIVES To determine the prevalence and incidence of crime victimization among persons with SMI by sex, race/ethnicity, and age, and to compare rates with general population data (the National Crime Victimization Survey), controlling for income and demographic differences between the samples. DESIGN Epidemiologic study of persons in treatment. Independent master's-level clinical research interviewers administered the National Crime Victimization Survey to randomly selected patients sampled from 16 randomly selected mental health agencies. SETTING Sixteen agencies providing outpatient, day, and residential treatment to persons with SMI in Chicago, Ill. PARTICIPANTS Randomly selected, stratified sample of 936 patients aged 18 or older (483 men, 453 women) who were African American (n = 329), non-Hispanic white (n = 321), Hispanic (n = 270), or other race/ethnicity (n = 22). The comparison group comprised 32 449 participants in the National Crime Victimization Survey. MAIN OUTCOME MEASURE National Crime Victimization Survey, developed by the Bureau of Justice Statistics. RESULTS More than one quarter of persons with SMI had been victims of a violent crime in the past year, a rate more than 11 times higher than the general population rates even after controlling for demographic differences between the 2 samples (P<.001). The annual incidence of violent crime in the SMI sample (168.2 incidents per 1000 persons) is more than 4 times higher than the general population rates (39.9 incidents per 1000 persons) (P<.001). Depending on the type of violent crime (rape/sexual assault, robbery, assault, and their subcategories), prevalence was 6 to 23 times greater among persons with SMI than among the general population. CONCLUSIONS Crime victimization is a major public health problem among persons with SMI who are treated in the community. We recommend directions for future research, propose modifications in public policy, and suggest how the mental health system can respond to reduce victimization and its consequences.
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Affiliation(s)
- Linda A Teplin
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 710 N. Lake Shore Drive, Chicago, IL 60611, USA.
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Teplin LA, Elkington KS, McClelland GM, Abram KM, Mericle AA, Washburn JJ. Major mental disorders, substance use disorders, comorbidity, and HIV-AIDS risk behaviors in juvenile detainees. Psychiatr Serv 2005; 56:823-8. [PMID: 16020814 PMCID: PMC1557408 DOI: 10.1176/appi.ps.56.7.823] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study determined the prevalence of 20 HIV-AIDS risk behaviors of four groups of juvenile detainees: those with major mental disorders alone, those with substance use disorders alone, those with comorbid mental and substance use disorders, and those without any major mental or substance use disorder. METHODS Interviewers administered the AIDS Risk Behavior Assessment to 800 randomly selected juvenile detainees aged ten to 18 years who were initially arrested between 1997 and 1998. Diagnoses were determined with the Diagnostic Interview Schedule for Children, Version 2.3. RESULTS The sample included 340 females and 460 males. As with the other groups of detainees, youths with major mental disorders had a high prevalence of most HIV-AIDS risk behaviors, much higher than the rates found among youths in the general population. Comorbid substance use disorders substantially increased risk; 96 percent of youths in this group had been sexually active, 62 percent had had multiple partners within the past three months, and 59 percent had had unprotected vaginal sex in the past month. Among youths with a substance use disorder, either alone or with a comorbid major mental disorder, more than 63 percent had engaged in five or more sexual risk behaviors. CONCLUSIONS Delinquents with substance use disorders, either with or without comorbid major mental disorders, are at particular risk of HIV-AIDS. The juvenile justice and public health systems must provide HIV-AIDS interventions as well as mental health and substance abuse treatment. Greater coordination between community services and correctional facilities can reduce the prevalence of HIV-AIDS risk behaviors of juvenile delinquents and stem the spread of HIV infection among young people.
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Affiliation(s)
- Linda A Teplin
- Department of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine at Northwestern University, Chicago, Illinois 60611, USA.
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Abstract
OBJECTIVE Youth processed in the juvenile justice system are at great risk for early violent death. Groups at greatest risk, ie, racial/ethnic minorities, male youth, and urban youth, are overrepresented in the juvenile justice system. We compared mortality rates for delinquent youth with those for the general population, controlling for differences in gender, race/ethnicity, and age. METHODS This prospective longitudinal study examined mortality rates among 1829 youth (1172 male and 657 female) enrolled in the Northwestern Juvenile Project, a study of health needs and outcomes of delinquent youth. Participants, 10 to 18 years of age, were sampled randomly from intake at the Cook County Juvenile Temporary Detention Center in Chicago, Illinois, between 1995 and 1998. The sample was stratified according to gender, race/ethnicity (African American, non-Hispanic white, Hispanic, or other), age (10-13 or > or =14 years), and legal status (processed as a juvenile or as an adult), to obtain enough participants for examination of key subgroups. The sample included 1005 African American (54.9%), 296 non-Hispanic white (16.2%), 524 Hispanic (28.17%), and 4 other-race/ethnicity (0.2%) subjects. The mean age at enrollment was 14.9 years (median age: 15 years). The refusal rate was 4.2%. As of March 31, 2004, we had monitored participants for 0.5 to 8.4 years (mean: 7.1 years; median: 7.2 years; interquartile range: 6.5-7.8 years); the aggregate exposure for all participants was 12944 person-years. Data on deaths and causes of death were obtained from family reports or records and were then verified by the local medical examiner or the National Death Index. For comparisons of mortality rates for delinquents and the general population, all data were weighted according to the racial/ethnic, gender, and age characteristics of the detention center; these weighted standardized populations were used to calculate reported percentages and mortality ratios. We calculated mortality ratios by comparing our sample's mortality rates with those for the general population of Cook County, controlling for differences in gender, race/ethnicity, and age. RESULTS Sixty-five youth died during the follow-up period. All deaths were from external causes. As determined by using the weighted percentages to estimate causes of death, 95.5% of deaths were homicides or legal interventions (90.1% homicides and 5.4% legal interventions), 1.1% of all deaths were suicides, 1.3% were from motor vehicle accidents, 0.5% were from other accidents, and 1.6% were from other external causes. Among homicides, 93.0% were from gunshot wounds. The overall mortality rate was >4 times the general-population rate. The mortality rate among female youth was nearly 8 times the general-population rate. African American male youth had the highest mortality rate (887 deaths per 100000 person-years). CONCLUSIONS Early violent death among delinquent and general-population youth affects racial/ethnic minorities disproportionately and should be addressed as are other health disparities. Future studies should identify the most promising modifiable risk factors and preventive interventions, explore the causes of death among delinquent female youth, and examine whether minority youth express suicidal intent by putting themselves at risk for homicide.
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Affiliation(s)
- Linda A Teplin
- Psycho-legal Studies Program, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Abstract
OBJECTIVE To estimate the 6-month prevalence of multiple substance use disorders (SUDs) among juvenile detainees by demographic subgroups (sex, race/ethnicity, age). METHOD Participants were a randomly selected sample of 1,829 African American, non-Hispanic white, and Hispanic detainees (1,172 males, 657 females, aged 10 to 18). Patterns and prevalence of DSM-III-R multiple SUDs were assessed using the Diagnostic Interview Schedule for Children Version 2.3. The authors used two-tailed F and t tests with an alpha of .05 to examine combinations of SUDs by sex, race/ethnicity, and age. RESULTS Nearly half of the detainees had one or more SUDs; more than 21% had two or more SUDs. The most prevalent combination of SUDs was alcohol and marijuana use disorders (17.25% females, 19.42% males). Among detainees with any SUD, almost half had multiple SUDs. Among detainees with alcohol use disorder, more than 80% also had one or more drug use disorders. Among detainees with a drug use disorder, approximately 50% also had an alcohol use disorder. CONCLUSIONS Among detained youths with any SUD, multiple SUDs are the rule, not the exception. Substance abuse treatments need to target detainees with multiple SUDs who, upon release, return to communities where services are often unavailable. Clinicians can help ensure continuity of care by working with juvenile courts and detention centers.
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Affiliation(s)
- Gary M McClelland
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Abram KM, Teplin LA, Charles DR, Longworth SL, McClelland GM, Dulcan MK. Posttraumatic stress disorder and trauma in youth in juvenile detention. Arch Gen Psychiatry 2004; 61:403-10. [PMID: 15066899 PMCID: PMC2861915 DOI: 10.1001/archpsyc.61.4.403] [Citation(s) in RCA: 255] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine prevalence estimates of exposure to trauma and 12-month rates of posttraumatic stress disorder (PTSD) among juvenile detainees by demographic subgroups (sex, race/ethnicity, and age). DESIGN Epidemiologic study of juvenile detainees. Master's level clinical research interviewers administered the PTSD module of the Diagnostic Interview Schedule for Children, version IV (DISC-IV), to randomly selected detainees. SETTING A large, temporary detention center for juveniles in Cook County, Illinois (which includes Chicago and surrounding suburbs). PARTICIPANTS Randomly selected, stratified sample of 898 African American, non-Hispanic white, and Hispanic youth (532 males, 366 females, aged 10-18 years) arrested and newly detained. MAIN OUTCOME MEASURES Diagnostic Interview Schedule for Children, version IV. RESULTS Most participants (92.5%) had experienced 1 or more traumas (mean, 14.6 incidents; median, 6 incidents). Significantly more males (93.2%) than females (84.0%) reported at least 1 traumatic experience; 11.2% of the sample met criteria for PTSD in the past year. More than half of the participants with PTSD reported witnessing violence as the precipitating trauma. CONCLUSION Trauma and PTSD seem to be more prevalent among juvenile detainees than in community samples. We recommend directions for research and discuss implications for mental health policy.
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Affiliation(s)
- Karen M Abram
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Abstract
OBJECTIVE To estimate 6-month prevalence of comorbid psychiatric disorders among juvenile detainees by demographic subgroups (sex, race/ethnicity, and age). DESIGN Epidemiologic study of juvenile detainees. Master's level clinical research interviewers administered the Diagnostic Interview Schedule for Children Version 2.3 to randomly selected detainees. SETTING A large temporary detention center for juveniles in Cook County, Illinois (which includes Chicago and surrounding suburbs). PARTICIPANTS Randomly selected, stratified sample of 1829 African American, non-Hispanic white, and Hispanic youth (1172 males, 657 females, aged 10-18 years) arrested and newly detained. MAIN OUTCOME MEASURE Diagnostic Interview Schedule for Children. RESULTS Significantly more females (56.5%) than males (45.9%) met criteria for 2 or more of the following disorders: major depressive, dysthymic, manic, psychotic, panic, separation anxiety, overanxious, generalized anxiety, obsessive-compulsive, attention-deficit/hyperactivity, conduct, oppositional defiant, alcohol, marijuana, and other substance; 17.3% of females and 20.4% of males had only one disorder. We also examined types of disorder: affective, anxiety, substance use, and attention-deficit/hyperactivity or behavioral. The odds of having comorbid disorders were higher than expected by chance for most demographic subgroups, except when base rates of disorders were already high or when cell sizes were small. Nearly 14% of females and 11% of males had both a major mental disorder (psychosis, manic episode, or major depressive episode) and a substance use disorder. Compared with participants with no major mental disorder (the residual category), those with a major mental disorder had significantly greater odds (1.8-4.1) of having substance use disorders. Nearly 30% of females and more than 20% of males with substance use disorders had major mental disorders. Rates of some types of comorbidity were higher among non-Hispanic whites and older adolescents. CONCLUSIONS Comorbid psychiatric disorders are a major health problem among detained youth. We recommend directions for research and discuss how to improve treatment and reduce health disparities in the juvenile justice and mental health systems.
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Affiliation(s)
- Karen M Abram
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 710 N. Lakeshore Drive, Chicago, IL 60612, USA
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Teplin LA, Mericle AA, McClelland GM, Abram KM. HIV and AIDS risk behaviors in juvenile detainees: implications for public health policy. Am J Public Health 2003; 93:906-12. [PMID: 12773351 PMCID: PMC1447866 DOI: 10.2105/ajph.93.6.906] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2002] [Indexed: 11/04/2022]
Affiliation(s)
- Linda A Teplin
- Psycho-Legal Studies Program, The Feinberg School of Medicine, Dept of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL 60611, USA.
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Abstract
OBJECTIVE This article presents the prevalence, patterns, and sequences of severe psychiatric disorders and substance use disorders among female jail detainees. METHOD Subjects were a randomly selected, stratified sample of 1,272 female arrestees awaiting trial at the Cook County Department of Corrections in Chicago. Independent clinical research interviewers administered the National Institute of Mental Health Diagnostic Interview Schedule Version III-R to assess comorbid psychiatric disorders and substance use disorders. RESULTS Eight percent of the women had both a current severe mental disorder and a current substance use disorder. Nearly three-quarters of those with severe mental disorders also met criteria for one or more substance use disorders. CONCLUSIONS Because most detainees return to their communities in a few days, these findings have implications for treatment of high-risk women throughout the mental health system.
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Affiliation(s)
- Karen M Abram
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Suite 900, 710 North Lakeshore Drive, Chicago, IL 60611, USA.
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Abstract
BACKGROUND Given the growth of juvenile detainee populations, epidemiologic data on their psychiatric disorders are increasingly important. Yet, there are few empirical studies. Until we have better epidemiologic data, we cannot know how best to use the system's scarce mental health resources. METHODS Using the Diagnostic Interview Schedule for Children version 2.3, interviewers assessed a randomly selected, stratified sample of 1829 African American, non-Hispanic white, and Hispanic youth (1172 males, 657 females, ages 10-18 years) who were arrested and detained in Cook County, Illinois (which includes Chicago and surrounding suburbs). We present 6-month prevalence estimates by demographic subgroups (sex, race/ethnicity, and age) for the following disorders: affective disorders (major depressive episode, dysthymia, manic episode), anxiety (panic, separation anxiety, overanxious, generalized anxiety, and obsessive-compulsive disorders), psychosis, attention-deficit/hyperactivity disorder, disruptive behavior disorders (oppositional defiant disorder, conduct disorder), and substance use disorders (alcohol and other drugs). RESULTS Nearly two thirds of males and nearly three quarters of females met diagnostic criteria for one or more psychiatric disorders. Excluding conduct disorder (common among detained youth), nearly 60% of males and more than two thirds of females met diagnostic criteria and had diagnosis-specific impairment for one or more psychiatric disorders. Half of males and almost half of females had a substance use disorder, and more than 40% of males and females met criteria for disruptive behavior disorders. Affective disorders were also prevalent, especially among females; more than 20% of females met criteria for a major depressive episode. Rates of many disorders were higher among females, non-Hispanic whites, and older adolescents. CONCLUSIONS These results suggest substantial psychiatric morbidity among juvenile detainees. Youth with psychiatric disorders pose a challenge for the juvenile justice system and, after their release, for the larger mental health system.
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Affiliation(s)
- Linda A Teplin
- Psycho-Legal Studies Program, Department of Psychiatry and Behavioral Sciences, The Feinberg School of Medicine, Northwestern Univerity, 710 N Lake Shore Dr, Suite 900, Chicago, IL 60611, USA.
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Abstract
OBJECTIVES We examined the sexual and injection drug use HIV and AIDS risk behaviors of female jail detainees. METHODS The sample (n = 948) was stratified by charge type (felony vs misdemeanor) and race/ethnicity (African American, non-Hispanic White, Hispanic, other). RESULTS Non-Hispanic White women, women arrested for less serious charges, women who had prior arrests, women arrested on drug charges, and women with severe mental disorders were at especially high risk for sexual and injection drug transmission of HIV and AIDS. CONCLUSIONS Many women at risk for HIV and AIDS--women who use drugs, women who trade sex for money or drugs, homeless women, and women with mental disorders--eventually will cycle through jail. Because most jail detainees return to their communities within days, providing HIV and AIDS education in jail must become a public health priority.
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Affiliation(s)
- Gary Michael McClelland
- Psycho-Legal Studies Program, Northwestern University Medical School, Chicago, Ill 60611-3078, USA.
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Abstract
OBJECTIVE To explore the service needs of women in jail, the authors examined three pathways into prostitution: childhood sexual victimization, running away, and drug use. Studies typically have explored only one or two of these pathways, and the relationships among the three points of entry remain unclear. METHODS Data on 1,142 female jail detainees were used to examine the effects of childhood sexual victimization, running away, and drug use on entry into prostitution and their differential effects over the life course. RESULTS Two distinct pathways into prostitution were identified. Running away had a dramatic effect on entry into prostitution in early adolescence, but little effect later in the life course. Childhood sexual victimization, by contrast, nearly doubled the odds of entry into prostitution throughout the lives of women. Although the prevalence of drug use was significantly higher among prostitutes than among nonprostitutes, drug abuse did not explain entry into prostitution. CONCLUSIONS Running away and childhood sexual victimization provide distinct pathways into prostitution. The findings suggest that women wishing to leave prostitution may benefit from different mental health service strategies depending on which pathway to prostitution they experienced.
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Abstract
OBJECTIVES Many jail inmates have severe psychiatric disorders (e.g., schizophrenia, major affective disorders). The courts have mandated that detainees have a constitutional right to treatment. We investigated what proportion of female jail detainees needed mental health services, what proportion received services, and what variables predicted who received services. METHODS Trained interviewers administered a psychiatric evaluation (the NIMH Diagnostic Interview Schedule) to 1272 randomly selected female jail detainees during jail intake in a large Midwestern city. Project staff then documented whether women subsequently received services, using records and case files. RESULTS Of the women who needed services, 23.5% received them while they were in jail. Type of disorder, treatment history, and socio-demographic variables all affected the odds of a mentally ill woman's receiving services. CONCLUSIONS Correctional health care is a growing national public health problem. The magnitude of mental health service needs far exceeds current resources.
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Affiliation(s)
- L A Teplin
- Psycho-Legal Studies Program, Northwestern University Medical School, Chicago, III
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Abstract
BACKGROUND There are little epidemiologic data on psychiatric disorders of women in jails. Accurate data on female jail detainees are critical because of their increasing numbers and their unique treatment needs. METHODS Using the Diagnostic Interview Schedule, independent interviewers assessed a randomly selected, stratified sample of 1272 female jail detainees awaiting trial in Chicago, Ill. We tabulated lifetime and 6-month prevalence rates of disorders by race or ethnicity (African American, non-Hispanic white, Hispanic), age, and education and compared the jail rates with general population rates for women in the Epidemiologic Catchment Area program. We also examined whether or not psychiatric disorder was associated with the severity of the detainee's current arrest charges. RESULTS Over 80% of the sample met criteria for one or more lifetime psychiatric disorders; 70% were symptomatic within 6 months of the interview. The most common disorders were drug abuse or dependence, alcohol abuse or dependence, and post-traumatic stress disorder. Major depressive episode was the most prevalent major mental disorder. Rates were generally highest among non-Hispanic whites and among older detainees. Rates for all disorders were significantly higher than general population rates, except for schizophrenia. Most detainees with psychiatric disorders were arrested for nonviolent crimes. CONCLUSION These results suggest substantial psychiatric morbidity among female jail detainees.
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Affiliation(s)
- L A Teplin
- Department of Psychiatry, Northwestern University Medical School, Chicago, Illinois, USA
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Abstract
The authors examined whether jail detainees with schizophrenia, major affective disorders, alcohol or drug use disorders, or psychotic symptoms (hallucinations and delusions) are arrested more often for violent crimes six years after release than detainees with no disorders. Trained interviewers assessed 728 randomly selected male jail detainees using the National Institute of Mental Health Diagnostic Interview Schedule and then obtained follow-up arrest data for six years. Neither severe mental disorder nor substance abuse or dependence predicted the probability of arrest or the number of arrests for violent crime. Persons with symptoms of both hallucinations and delusions had a slightly higher number of arrests for violent crime, but not significantly so. These findings held even after controlling for prior violence and age. The findings do not support the stereotype that mentally ill criminals invariably commit violent crimes after they are released. Future directions for research are suggested.
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Affiliation(s)
- L A Teplin
- Northwestern University Medical School, Chicago, IL 60611
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Abstract
Studies have demonstrated that police often arrest the mentally ill when treatment alternatives would be preferable but are unavailable. Thus, jails may contain disproportionate numbers of severely mentally ill persons who have co-occurring disorders. Data on the co-occurrence of severe mental disorder, substance abuse, and antisocial personality disorders were gathered from 728 randomly selected male urban jail detainees. Using difference of proportions tests and loglinear analysis, the authors demonstrated that most subjects with a severe mental disorder (schizophrenia or a major affective disorder) also meet criteria for a substance abuse or antisocial personality disorder. These findings suggest several changes in public policy regarding health care delivery in correctional settings and for the general population.
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Affiliation(s)
- K M Abram
- Department of Psychiatry and Behavioral Sciences, Northwestern University Medical School, Chicago, IL 60611
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