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Psychiatric problems and suicidal behaviour in incarcerated adolescents in the Islamic Republic of Iran

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Psychiatric problems and suicidal behaviour in incarcerated adolescents in the Islamic Republic of Iran

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Data are lacking about the prevalence of psychiatric disorders and suicidal behaviour in incarcerated adolescents in Asia. This cross-sectional study evaluated the prevalence of psychiatric disorders and the prediction of suicidal attempts in 100 incarcerated males aged 12-19 years in Shiraz. Data were collected in face-to-face interview using the Kiddie Schedule for Affective Disorders and Schizophrenia (Farsi version). The mean age was 16.8 (SD 1.3) years and mean age at first imprisonment was 16.0 (SD 1.5) years. Nearly 70% of the adolescents had at least one current psychiatric disorder, the commonest being: conduct disorder (55%), oppositional defiant disorder (48%) and attention deficit hyperactivity disorder (33%); 11% had major depressive disorder and 2% schizophrenia. In all, 20% had self-harmed without intent to kill themselves and 12% had attempted suicide, 50% of whom had tried more than once. In logistic regression analysis only self-harming behaviour and major depressive disorder were significant predictors of attempted suicide.
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

311
Psychiatric problems and suicidal behaviour in
incarcerated adolescents in the Islamic Republic of Iran
A. Ghanizadeh,
1,2
S.Z. Nouri
2
and S.S. Nabi
2
ABSTRACT Data are lacking about the prevalence of psychiatric disorders and suicidal behaviour in incarcerated
adolescents in Asia. This cross-sectional study evaluated the prevalence of psychiatric disorders and the
prediction of suicidal attempts in 100 incarcerated males aged 12–19 years in Shiraz. Data were collected in
face-to-face interview using the Kiddie Schedule for Affective Disorders and Schizophrenia (Farsi version). The
mean age was 16.8 (SD 1.3) years and mean age at first imprisonment was 16.0 (SD 1.5) years. Nearly 70% of
the adolescents had at least one current psychiatric disorder, the commonest being: conduct disorder (55%),
oppositional defiant disorder (48%) and attention deficit hyperactivity disorder (33%); 11% had major depressive
disorder and 2% schizophrenia. In all, 20% had self-harmed without intent to kill themselves and 12% had
attempted suicide, 50% of whom had tried more than once. In logistic regression analysis only self-harming
behaviour and major depressive disorder were significant predictors of attempted suicide.
1
Research Center for Psychiatry and Behavioral Sciences;
2
Department of Psychiatry, Shiraz University of Medical Sciences, School of Medicine,
Hafez Hospital, Shiraz, Islamic Republic of Iran (Correspondence to A. Ghanizadeh: ghanizad@sina.tums.ac.ir).
Received: 31/08/10; accepted: 18/10/10
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Problèmes psychiatriques et comportement suicidaire des adolescents incarcérés en République islamique d'Iran
RÉSUMÉ Les données sont rares au sujet de la prévalence des troubles psychiatriques et du comportement
suicidaire des adolescents incarcérés en Asie. La présente étude transversale a évalué la prévalence des
troubles psychiatriques et le risque de tentatives de suicide chez 100 garçons âgés de 12 à 19 ans incarcérés
à Chiraz. Les données ont été recueillies lors d'entrevues individuelles à l'aide de la version en langue farsi
du questionnaire Kiddie Schedule for Affective Disorders and Schizophrenia. L'âge moyen des participants était
16,8 ans (écart type 1,3) et ils avaient 16,0 ans en moyenne (écart type 1,5) lors de leur premier séjour carcéral.
Près de 70 % des adolescents souffraient d'au moins un trouble psychiatrique courant. Les plus fréquents
étaient les suivants : trouble du comportement (55 %), trouble oppositionnel avec provocation (48 %) et trouble
déficitaire de l'attention avec hyperactivité (33 %) ; 11 % souffraient de dépression sévère et 2 % étaient atteints
de schizophrénie. Au total, 20 % s'étaient automutilés sans intention de se donner la mort et 12 % avaient tenté
de se suicider. Parmi ceux-ci, 50 % avaient fait plusieurs tentatives. Selon l'analyse de régression logistique, seuls
les comportements d'automutilation et la dépression sévère étaient des facteurs prédictifs importants d'une
tentative de suicide.
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Introduction
e Islamic Republic of Iran has a
very high proportion of young peo-
ple; about 33% of its population is
below 20 years of age. About 90% of
the studies on adolescents in juvenile
detention come from the United States
of America (USA) [1]. A systematic
review and meta-regression analysis of
25 surveys found that nearly all of them
reported that over two-thirds of the
adolescents suered from psychiatric
disorders [1]. Rates in other studies
in the USA, Canada and Europe are
also high (Table 1) [2–6]. Specically
the systematic review indicated that
the rate of psychotic illness, manic
episodes, major depression, aention
decit hyperactivity disorder (ADHD)
and conduct disorder in adolescents
in detention and correctional facilities
were 3.3%, 3.1%, 10.6%, 11.7% and
52.8% respectively [1].
Studies from other parts of the world
are few. No studies from Asia that inves-
tigated dierent psychiatric disorders in
incarcerated adolescents were found. A
study on psychiatric disorders in adult
prisoners in the Islamic Republic of Iran
reported that the rates of lifetime and
current psychiatric disorders were 88%
and 57% respectively [7].
Many previous studies have re-
lied on medical records [8] and self-
completed questionnaires and have
not assessed dierent psychiatric
disorders [9], or they studied mental
distress rather than psychiatric disor-
ders [10]. Some of the studies have
used DISC, a highly structured instru-
ment, to assess psychiatric disorders
[2] although it has been indicated
that some disorders such as ADHD
and depression are under-reported
using DISC [1].
To the best of our knowledge, this
is the rst study in Asia and the Islamic
Republic of Iran that investigated the
prevalence of psychiatric disorders
and suicidal behaviour in the incarcer-
ated adolescents. e present study
tries to ll this gap in the literature.
Assessment of psychiatric problems
of incarcerated adolescents is essential
for their management and treatment.
e aims of this study were to assess
the prevalence of psychiatric disor-
ders and the prediction of suicidal
aempts in incarcerated adolescents
in Shiraz, Southern Islamic Republic
of Iran.
Methods
Study sample and setting
is was a cross-sectional study con-
ducted in Adel Abad (Kanoon e Eslah
Va Tarbiat) Prison, which is the only
prison in Shiraz. Subjects of the present
study were a convenience sample of 100
boys aged < 20 years incarcerated in the
prison from July 2006 to April 2008.
Individuals older than 19 years were not
included.
Data collection
e adolescents were interviewed by 2
of the authors using the Farsi version of
the Kiddie Schedule for Aective Dis-
orders and Schizophrenia (K-SADS)
[11].
K-SADS is a semi-structured in-
terview based on DSM-IV diagnostic
criteria [12]. Many dierent psychiatric
disorders are evaluated by K-SADS, such
as major depressive disorder, psychosis,
bipolar disorder, obses
sive–compulsive
disorder, separation anxiety disorder,
generalized anxiety disorder, panic dis-
order, social phobia, agoraphobia and
specic phobia, tic disorder, aention
decit hyperactivity disorder, disrup-
tive behavioural disorder, anorexia and
Table 1 Previous studies from North America and Europe
Study Sample Instrument Results
Baltimore, USA [5] 120 referred incarcerated
youth
Diagnostic Interview Schedule for
Children and the Child Behavior
Checklist
96% had at least 1
psychiatric disorder
Illinois, USA [3] 1172 boys, 657 girls, aged 10–
18 years who were arrested
and detained
Diagnostic Interview Schedule for
Children version 2.3
40% of boys had at least 1
disorder
Canada [4] 49 incarcerated adolescents Diagnostic Interview for Children
and Adolescents Revised
(DICA-R)
63.3% had 2 or more
psychiatric disorders
Belgium [15] 72 delinquent adolescents Semi-structured assessment
(Child Assessment Schedule) and
self-report measures
70% had at least 1
psychiatric diagnosis
Denmark [6] 100 incarcerated boys aged
15–17 years
Interviewed using ICD-10
diagnostic criteria
69% had “any mental
disorder”; 2% had
schizophrenia
Netherlands [2] 204 incarcerated boys aged
12–18 years
Diagnostic Interview Schedule for
Children (DISC)
90% had at least 1
psychiatric disorder



313
bulimia nervosa, and enuresis. It has
been used in several studies in the Is-
lamic Republic of Iran [13,14].
Subsyndromal episodes include
the presence of 2 or more key symp-
toms of the disorder but the symptoms
do not present severely enough to lead
to the diagnosis of the disorder or they
have not met full diagnostic criteria ac-
cording to DSM IV. e validity, reli-
ability, sensitivity and specicity of the
Farsi version have been documented
[11].
e adolescents were interviewed
face to face individually in the prison by
2 of the authors (SZN and SSN).
Ethical issues
e study was approved by the
Deputy of Research Aairs of Shiraz
University of Medical Sciences. In
addition the authorities of the prison
gave permission to conduct the study
which was done in accordance with
the Declaration of Helsinki as revised
in 1996 (hp://www.wma.net/
en/30publications/10policies/b3/in-
dex.html). Before starting the interview,
we informed the adolescents about
the aim of our research and gave them
the option to participate or not and to
withdraw whenever they wanted. e
participants were assured that the an-
swers would be condential. All agreed
to participate and gave their verbal
informed consent; none dropped out
during the study.
If a respondent had an acute psychi-
atric problem, with his permission, the
authorities were informed and advised.
Data analysis
Data were analysed using SPSS for
Windows, version 14. Descriptive
analysis was conducted to examine
the frequency of the disorders. Binary
logistic regression analysis was used to
determine the probable predictors of at-
tempted suicide. e co-occurrence of
psychiatric disorders, including ADHD,
conduct disorder, oppositional de-
ant disorder, self-harm behaviour, and
major depressive disorder and tobacco
use, was considered as a possible inde-
pendent predictor of suicidal behaviour.
Results
e sociodemographic characteristics
of the adolescents and their parent are
shown in Table 2. e mean length of
their current imprisonment was 172
(SD 191.6) days with a range of 30 to
730 days. e mean of the number of
times which they had been incarcerated
was 1.35 (SD 0.72) times with a range
of 1–4 times.
As regards birth order, 32% of the
adolescents were the last child in the
family and 29% were the rst. For 20%
of the adolescents, their father was dead
and for 11% their mother had died. As
regards parental employment, 10% of
the fathers were unemployed and the
others were mostly unskilled worker,
while the majority of the mothers were
housewives. e mean age at rst im-
prisonment was 16.0 (SD 1.5) years and
23% of the adolescents had been impris-
oned more than once. e causes of rst
time imprisonment (self-reported by 77
of the sample) were non-armed robbery
(43.4%) and ghting (39.1%), but 33%
of the adolescents did not report why
they had been imprisoned the rst time.
e reasons for their current impris-
onment were robbery (26%), murder
(23%), ghting (21%), other, such as
drug dealing (16%), and kidnapping
(14%).
In all, 12% reported a positive his-
tory of aempted suicide and 50% with
a positive history of aempted suicide
had tried more than once. e mean
age at the rst suicide aempt was 15.7
(SD 1.7) years, range 12–17 years. Only
1% of the sample reported a positive
family history of suicide. Of the whole
sample, 20% reported that they had
injured themselves without intent to kill
themselves.
e commonest disorders
found were: conduct disorder 55%,
oppositional deant disorder 48%,
ADHD 33% and major depressive
disorder 11%; schizophrenia was diag-
nosed in 2% (Table 3). ere were no
cases of bipolar disorder, panic disorder,
separation anxiety disorder, generalized
anxiety disorder, social phobia, agora-
phobia, anorexia and bulimia nervosa,
enuresis or encopresis.
Some participants did not full all
the diagnostic criteria for a disorder
but had at least 2 major key symptoms
of the disorder. ese were considered
subsyndromal cases. e commonest
subsyndromal disorders were: ADHD
27%, major depressive disorder 24%,
post-traumatic stress disorder 20%,
generalized anxiety disorder 18%, social
phobia 16%, oppositional deant dis-
order 14%, separation anxiety disorder
12% and conduct disorder 11% (Table
3).
e life-time (excluding the past
year) prevalence for ADHD was 72%,
for oppositional deant disorder it was
55%, for conduct disorder it was 52%,
and for enuresis it was 12% (Table 4).
On binary logistic regression the
only signicant predictors of suicide
aempt were self-harm behaviour (P
< 0.001) and major depressive dis-
order (P = 0.034). None of the other
disorders predicted aempted suicide
(Table 5).
Discussion
Our results show that the prevalence
of some psychiatric disorders and
symptoms in our sample of adolescent
prison inmates was high. Over half of
them suered from conduct disorder
and one-third had ADHD. We had no
control group with which to compare
our results.
To the best of our knowledge, this
is the rst study to evaluated the preva-
lence of dierent psychiatric disorders
using face-to-face interview in incar-
cerated adolescents in a non-Western
country. ere are no published data
EMHJ •  Vol. 18  No. 4  •  2012
Eastern Mediterranean Health Journal
La Revue de Santé de la Méditerranée orientale
314
from the Islamic Republic of Iran to
compare our results with.
ere have been many studies in
non-Asian countries and while there
is a considerable variety among the
methods used, sample size and the in-
struments used, there are signicant
similarities between their results and
ours. Not considering subsyndromal
group, nearly 70% of the adolescents
in our study had at least 1 current psy-
chiatric disorder: 14% had 1 disorder
(21% life-time), 28% had 2 disorders
(23% life-time) and 28% had 3 or more
disorders (45% life-time). ese nd-
ings are similar or sometimes higher
than found in American adolescent
detainees [3,5] (Table 1). More than
two-thirds of incarcerated adolescents
had at least 1 psychiatric disorder [5].
Similar high prevalence rates have
been reported from the Netherlands,
Canada, Belgium, Denmark and Brazil
[2,4,6,15,16], (Table 1). For example,
the study from Canada reported that
63% of incarcerated adolescents had at
least 2 psychiatric disorder [4], while the
study from the Netherlands reported
that 90% of their subjects had at least
1 disorder [2]. In Brazil the rates were
54% for ADHD, 77% for conduct dis-
order and 41% for oppositional deant
disorder [16].
ere are few studies from Asia.
One study in Japan studied only the
prevalence of post-traumatic disorder
(PTSD) by PTSD Scale. e research-
ers found that 21% of the incarcerated
youth had a current or past history of
full PTSD and 21% had partial PTSD
[9]. In our study, the rate of subsyndro-
mal PTSD was 20%. A study in Korea
that assessed only ADHD in juvenile
delinquents found a rate of ADHD of
42.4% [17]. ese rates are very similar
to those of our study.
It has been reported that knowledge
about psychiatric disorders (ADHD)
and symptoms among many families
and teachers in the Islamic Republic
of Iran is so low that they cannot, even
if they want to, help their children
Table 2 Sociodemographic characteristics of the male adolescent prisoners and
their parents
Variable Value
Adolescents
Age and education
Mean age (SD) in years 16.7 (1.28)
Age range (years) 12–19
Mean (SD) years of education 6 (3.29)
Year of education range 0–12
Family income (rials): % reporting:
2 000 000–4 000 000 28
> 4 000 000 10
< 2 000 000 58
Mean (SD) number of siblings 5.30 (2.71)
Range of number of siblings 1–14
Birth order: %
1 29
Middle 39
Last 32
Mean (SD) age at first imprisonment in years 16.05 (1.50)
Imprisoned > 1 time (%) 23
Main reported reason for first imprisonment (%) (n = 77)
Non-armed robbery 43.4
Fighting 39.1
Drug dealing 8.7
Drunkenness 4.3
Other (e.g. drug dealing) 4.3
Reason for their current imprisonment
Robbery 26
Murder 23
Fighting 21
Kidnapping 14
Other (e.g. drug dealing) 16
Parents
Deceased
Mean (SD) years of mothers education 3.60 (4.44)
Father dead 20
Mother dead 11
Father’s occupation
Unemployed 10
Unskilled worker 21
Other 69
Mother’s occupation
Housewife 77
Unskilled worker 8
Other 15
SD = standard deviation.
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
315
[18]. One study in Islamic Republic
of Iran suggests that even the knowl-
edge of g
eneral practitioners needs to
be improved [19]. Many families do
not know that hyperactivity may be a
symptom of a disorder, or that frequent
stealing by a child in the early years of
school can be a rst symptom of a dis-
order. In addition, most of the parents
of the incarcerated adolescents in our
study had a low level of education and
likely had no idea what a psychiatric
disorder is. Previous studies in the Is-
lamic Republic of Iran have reported
that children with ADHD have less
organized and more conicting inter-
personal relationships within their fam-
ily [20] and in a sample of children with
ADHD, it was reported that 48.1%
and 43.0% of the mothers and fathers
respectively suered from depressive
disorder [14]. us, adolescents from
dicult or uneducated backgrounds
may be at greater risk for certain psy-
chiatric disorders or may have lile or
no support for their condition, which
may lead to problems with the law and
subsequent incarceration.
e prevalence of ADHD, conduct
disorder and oppositional deant dis-
order were high in our study (Tables 3
and 4). It has been shown in American
studies that adolescents with ADHD
and conduct disorder have a history of
arrest at an earlier age and have more
total arrest than other children [21,22].
is risk is also higher in the adulthood
[21]. In other words, ADHD children
have a higher risk of commiing crimes
and of being arrested and incarcerated
[22].
Suicidal behaviour is high among
incarcerated adolescents [23]. A study
among 271 incarcerated male juvenile
delinquents diagnosed with conduct
disorder reported that 34% of them
had a lifetime history of either suicidal
thoughts or aempts [24]. Young peo-
ple who have self-harming behaviour
have an increased risk of complete sui-
cide and the two are strongly correlated
[25]. e rate of aempted suicide in
our country is about 1% among adult
males [26]. In our study, 20 (20%) ado-
lescents had self-harming behaviour,
most of whom were repeated self-harm-
ers. Among these, 10 (50%) individuals
had a history of suicide. us, overall the
frequency of aempted suicide among
our sample was 12%, much higher than
the 1% reported among adult males in
the Islamic Republic of Iran [26]. In re-
gression analysis, only self-harming be-
haviour and major depression predicted
aempted suicide. e diagnosis, man-
agement and treatment of self-harming
behaviour and major depression among
incarcerated adolescents could help
prevent repetition and would be helpful
for both the adolescents and juvenile
justice system.
Limitations
ere are some limitations to the cur-
rent study. e sample was chosen
from only 1 prison in southern Islamic
Republic of Iran and only the axis I
disorders were studied and were only
assessed using self-reported informa-
tion. For nancial constraints, we were
only able to include 100 adolescents
who were available for interview dur-
ing the study period. erefore, these
results cannot be generalized to other
prisoners or community samples. We
could not also assess a control group
from a community sample to compare
Table 3 Frequency of current psychiatric disorders and subsyndromes in the
incarcerated adolescents (n = 100)
Disorder Current
psychiatric
disorders
Current
subsyndromes
% %
Major depressive disorder 11 24
Mania 0 2
Psychosis 2 4
Separation anxiety disorder 0 18
Social phobia 0 16
Generalized anxiety disorder 0 18
Obsessive–compulsive disorder 9 3
Attention deficit hyperactivity disorder 33 27
Panic disorder 0 2
Oppositional disorder 48 14
Conduct disorder 55 11
Agoraphobia 0 3
Tic disorder 8 1
Post-traumatic stress disorder 0 20
Nicotine use 33
Table 4 Frequency of life-time (excluding the past year) prevalence of psychiatric
disorders and subsyndromes among incarcerated adolescent males (n = 100)
Disorder
Psychiatric disorders Subsyndromes
% %
Enuresis 12 0
ADHD 72 13
Oppositional disorder 55 13
Conduct disorder 52 19
ADHD = attention deficit hyperactivity disorder.
EMHJ •  Vol. 18  No. 4  •  2012
Eastern Mediterranean Health Journal
La Revue de Santé de la Méditerranée orientale
316
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our results with. However, we are now
undertaking another study on the
prevalence of psychiatric disorders
among a sample of adolescents in the
community. Finally, as previous studies,
it is a cross-sectional study and so a
causal relationship between psychiatric
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Table 5 Predictors of suicidal attempt in male adolescents prisoners
Variable Odds ratio (95% CI) P-value
Age 1.637 (0.728–3.681) 0.233
Educational level 1.050 (0.715–1.540) 0.804
ADHD 0.958 (0.116–7.882) 0.968
Oppositional defiant
disorder 1.190 (0.062–22.738) 0.908
Conduct disorder 0.686 (0.034–13.954) 0.806
Self-injury behaviours 72.743 (6.521–811.412) < 0.001
Tobacco use 2.337 (0.402–13.587) 0.345
Major depressive disorder 19.927 (1.246–318.742)
0.034
CI = confidence interval.
ADHD = attention deficit hyperactivity disorder.
Despite these limitations, this is the
rst study from a non-Western country
that included so many dierent psychi-
atric disorders, using a semi-structured
instrument with tested validity, reliabil-
ity, sensitivity and specicity with the re-
spondents being interviewed face to face.
In addition, both of psychiatric disorders
and subsyndromes were examined.
Conclusion
In conclusion, our ndings show that the
prevalence of psychiatric disorders was
very high among the incarcerated adoles-
cents. is suggests that all adolescents
in the juvenile justice system should be
screened for psychiatric disorders, and
those with disorders should receive treat-
ment to manage their condition both in
prison and aer their release from prison.
Acknowledgements
We thank the participants and the
authorities of the prison. is research
was funded in part by a grant from the
Chancellor of Research Aairs of Shiraz
University of Medical Sciences. All the
results and comments expressed here are
those of the authors and do not necessar-
ily represent the ocial position or policy
of the Department of Justice or university.
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Mental health and development: targeting people with mental health conditions as a vulnerable group
Mental health and development: targeting people with mental health conditions as a vulnerable group is a call to action to all
development stakeholders – governments, civil society, multilateral agencies, bilateral agencies, global partnerships,
private foundations, academic and research institutions – to focus their aention on mental health.
e report presents compelling evidence that persons with mental and psychosocial disabilities are a vulnerable group
but continue to be marginalized in terms of development aid and government aention. It makes the case for reaching
out to this group through the design and implementation of appropriate policies and programmes and through the
inclusion of mental health interventions into broader poverty reduction and development strategies. e report also
describes a number of key interventions which can provide a starting point for these eorts. By investing in persons with
mental and psychosocial disabilities, development outcomes can be improved.
Further information about this and other WHO publications is available at: hp://www.who.int/publications/en/
... Through our updated search, we found 22 new surveys. 12,19,21,27,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] We combined them with the 25 surveys identified in the previous review. 28, Two studies 12,69 were based on the same sample, which provided 12,28,40,42,[50][51][52][53]57,[59][60][61]63,66,68,69,72,73 ; six were from the United Kingdom (n ¼ 1,145) 27,44,54,55,62,64 ; three were from Canada (n ¼ 408) 37,38,70 ; two each were from Australia (n ¼ 384), 41,56 Brazil (n ¼ 143), 35,49 Russia (n ¼ 740), 45,67 and the Netherlands (n ¼ 416) 39,71 ; and one each was from Austria (n ¼ 259), 33 Belgium (n ¼ 245), 19 China (n ¼ 232), 47 Denmark (n ¼ 100), 58 Germany (n ¼ 38), 43 Iran (n ¼ 100), 36 Japan (n ¼ 48), 48 Malaysia (n ¼ 105), 34 Norway (n ¼ 40), 46 South Korea (n ¼ 173), 21 Spain (n ¼ 35), 65 and Switzerland (n ¼ 158). ...
... 37,39,40,43,46,47,67,68 Three studies (n ¼ 335) did not report on their sampling method. 36,38,70 Response rates were reported in 38 studies, 12,19,21,27,[32][33][34]36,39,[41][42][43][44][45][46][47][48][49]51,[53][54][55][56][57][58][59][61][62][63][65][66][67][68][69][70][71][72][73] and only seven of them (n ¼ 1,317) reported rates 75%. 19,51,57,58,61,63,71 Interviews were conducted using the following instruments: 12 48 or a semistructured interview. ...
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It has never been investigated whether the assessment tools of Adult Attention Deficit Hyperactivity Disorder Quality-of-Life (AAQoL) scale and the SF-36 measure the same construct. The participants were 101 parents of children with ADHD and 243 parents of school children. The parents completed both the Persian version of the AAQoL and the SF-36 questionnaires. The present study revealed that the Persian version of both AAQoL and SF-36 for the assessment of HRQoL in parents of children with ADHD has convergent and discriminant validity and internal consistency. Multitrait–multimethod correlation matrix showed that the domains of two questionnaires were moderately correlated. Current results support that AAQoL and SF-36 in parents of children with ADHD measure the same HRQoL constructs. Hence, for assessing the HRQoL of parents of children with ADHD, one of the two questionnaires can be used regard to the objective of study. The Persian version of the AAQoL loaded on four domains which were in line with the original version. HRQoL of parents of children with ADHD is markedly less than the community sample of children.
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Attention deficit hyperactivity disorder is one of the most common child psychiatry disorders. General physicians (GP), as primary care providers, can have an important role in screening and treatment of ADHD. This study aimed to survey GPs' knowledge, attitude, and their views of their role in the screening, diagnosing and managing children with ADHD. Six hundred and sixty five general physicians in Shiraz, Iran, answered a self-reported questionnaire on ADHD. The questionnaire consisted of questions regarding socio-demographic characteristics such as age, the duration of practice as a GP, marital status, general knowledge about ADHD, and the management of ADHD. Less than half of them believed that they have adequate knowledge and information about this disorder. They usually do not like to be the primary care providers for children with ADHD. The majority of them prefer to refer the children to related specialists, mostly psychiatrists or psychologists. More than one third of them believed that sugar is a cause of ADHD. Only 6.6% of them reported that ADHD persists for the whole life. Their knowledge about methylphenidate is reasonable. As many other countries worldwide, the knowledge of GPs about ADHD should be improved. They do not asses and manage children with probable ADHD by themselves without referring to related professionals. They do not opt for the use of methylphenidate.
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To determine the prevalence of psychiatric disorders, the degree of psychiatric comorbidity, and the relationship between these and sociodemographic variables in a sample of incarcerated adolescents. A comparison with an age- and sex-matched community sample was conducted. Age- and sex-matched samples of 49 incarcerated adolescents and 49 nondelinquents were compared for psychiatric morbidity and psychosocial characteristics. Psychiatric diagnoses were determined using the Diagnostic Interview for Children and Adolescents-Revised (DICA-R). Additional information on psychosocial, family, and offence characteristics was obtained using a semistructured interview designed specifically for this study. The prevalence of single and comorbid psychiatric disorders was determined. Approximately 63.3% of incarcerated adolescents had 2 or more psychiatric disorders. The degree of psychiatric morbidity was directly related to indicators of family adversity, physical abuse, other psychosocial variables, or polysubstance abuse. Psychiatric comorbidity was more frequent in females. Incarcerated adolescents were more likely to endorse symptoms of thought disorder. Findings identify preventive intervention foci for policy makers and planners in the area of adolescent corrections. Implications for education and training of nonclinical custodial staff are discussed as is the need for a more therapeutic orientation in correctional facilities.
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Objectives To determine the prevalence of psychiatric disorders, the degree of psychiatric comorbidity, and the relationship between these and sociodemographic variables in a sample of incarcerated adolescents. A comparison with an age- and sex-matched community sample was conducted. Method Age- and sex-matched samples of 49 incarcerated adolescents and 49 nondelinquents were compared for psychiatric morbidity and psychosocial characteristics. Psychiatric diagnoses were determined using the Diagnostic Interview for Children and Adolescents-Revised (DICA-R). Additional information on psychosocial, family, and offence characteristics was obtained using a semistructured interview designed specifically for this study. The prevalence of single and comorbid psychiatric disorders was determined. Results Approximately 63.3% of incarcerated adolescents had 2 or more psychiatric disorders. The degree of psychiatric morbidity was directly related to indicators of family adversity, physical abuse, other psychosocial variables, or polysubstance abuse. Psychiatric comorbidity was more frequent in females. Incarcerated adolescents were more likely to endorse symptoms of thought disorder. Conclusions Findings identify preventive intervention foci for policy makers and planners in the area of adolescent corrections. Implications for education and training of nonclinical custodial staff are discussed as is the need for a more therapeutic orientation in correctional facilities.
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This study was conducted to identify attention deficit hyperactivity disorder (ADHD) in Korean juvenile delinquents. Intelligence tests (KEDI-WISC, KWAIS), the Test of Variables of Attention (TOVA), the Teacher Report Form (TRF), the Youth Self-Report (YSR), and the Rosenberg Self-Esteem Scale were administered to 98 incarcerated Korean adolescents (the delinquent group) and 84 adolescent nondelinquents (the control group). The groups were compared, and significant differences were found for ADHD; 42.4% of the adolescents in the delinquent group were identified as having ADHD, in comparison to 11.9% of the adolescents in the control group. Delinquent adolescents and adolescents with ADHD were found to have lower IQ scores, poorer TOVA performance, more severe problem behaviors, and lower self-esteem than nondelinquent adolescents and adolescents without ADHD. Delinquent adolescents with ADHD consistently fared the worst on assessments of intelligence, TOVA performance, problem behaviors, and self-esteem.
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Objective: To compare Children's Perceived Parent-Child Relationships (PCR) and family functioning in children with Attention-Deficit/Hyperactivity Disorder (ADHD) and a general population sample.Method: A total of 49 ADHD subjects and 51 subjects without any psychiatric disorder were matched for age, sex, educational level, family income, level of parental education, ethnicity, and residential area. Family Assessment and PCR survey were used.Results: The families of ADHD children had higher levels of difficulty in their relationships. Their problem-solving ability, communication, affective responsiveness, and affective involvement were less than those in the other group. There was a poorer PCR in the ADHD families.Conclusions: Interpersonal relations are more conflicting and less organized in the families of children with ADHD. PCR should be promoted in ADHD children.
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There are controversial or even opposite findings about gender and prevalence of comorbid psychiatric disorders among different subtypes of attention-deficit hyperactivity disorder (ADHD). The participants were children with attention-deficit hyperactivity disorder. Gender, subtype of attention-deficit hyperactivity disorder, and the interaction effects were evaluated by logistic regression. Of the 171 children, 73 (42.7%) were of the combined subtype, 45 (26.3%) inattentive, and 52 (31.0%) were hyperactive/impulsive. The prevalence of attention-deficit hyperactivity disorder subtypes was not different between genders. There was no significant difference of gender by subtype interaction effects on the children's age. This study does not provide evidence supporting attention-deficit hyperactivity disorder subtypes as distinct clinical entities in terms of comorbidity. Association of attention-deficit hyperactivity disorder subtypes and psychiatric disorders in Iran is somehow different from that in some studies conducted in the Western culture. It is more similar to that of other Asian countries.
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To systematically review and perform a meta-analysis of the research literature on the prevalence of mental disorders in adolescents in juvenile detention and correctional facilities. Surveys of psychiatric morbidity based on interviews of unselected populations of detained children and adolescents were identified by computer-assisted searches, scanning of reference lists, hand-searching of journals, and correspondence with authors of relevant reports. The sex-specific prevalence of mental disorders (psychotic illness, major depression, attention-deficit/hyperactivity disorder [ADHD], and conduct disorder) together with potentially moderating study characteristics were abstracted from publications. Statistical analysis involved metaregression to identify possible causes of differences in disorder prevalence across surveys. Twenty-five surveys involving 13,778 boys and 2,972 girls (mean age 15.6 years, range 10-19 years) met inclusion criteria. Among boys, 3.3% (95% confidence interval [CI] 3.0%-3.6%) were diagnosed with psychotic illness, 10.6% (7.3%-13.9%) with major depression, 11.7% (4.1%-19.2%) with ADHD, and 52.8% (40.9%-64.7%) with conduct disorder. Among girls, 2.7% (2.0%-3.4%) were diagnosed with psychotic illness, 29.2% (21.9%-36.5%) with major depression, 18.5% (9.3%-27.7%) with ADHD, and 52.8% (32.4%-73.2%) with conduct disorder. Metaregression suggested that surveys using the Diagnostic Interview Schedule for Children yielded lower prevalence estimates for depression, ADHD, and conduct disorder, whereas studies with psychiatrists acting as interviewers had lower prevalence estimates only of depression. Adolescents in detention and correctional facilities were about 10 times more likely to suffer from psychosis than the general adolescent population. Girls were more often diagnosed with major depression than were boys, contrary to findings from adult prisoners and general population surveys. The findings have implications for the provision of psychiatric services for adolescents in detention.
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To examine the relationship between attention deficit disorder with hyperactivity in childhood and criminality in adolescence and adulthood in 89 hyperactive and 87 normal control subjects. In this prospective study, adolescent follow-up intervals ranged from 13 to 21 years and adult follow-up ranged from 18 to 23 years. The official arrest records for all subjects were obtained. Hyperactive subjects had significantly higher juvenile (46% versus 11%) and adult (21% versus 1%) arrest rates. Juvenile and adult incarceration rates were also significantly higher. Childhood conduct problems predicted later criminality, and serious antisocial behavior in adolescence predicted adult criminality. Hyperactive children are at risk for both juvenile and adult criminality. The risk for becoming an adult offender is associated with conduct problems in childhood and serious antisocial behavior (repeat offending) in adolescence. Hyperactive children who do not have conduct problems are not at increased risk for later criminality.
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To examine the relation between personality traits and criminal behavior and to determine whether such factors are predictive of future recidivism. A sample of 481 incarcerated males (mean age = 16 years) completed questionnaires assessing distress and restraint relating to personality characteristics. In addition, official criminological data were gathered from subjects' records. A subsample of 148 juveniles was followed up to 4.5 years after release and examined for rearrests and time out of prison since last incarceration. Results indicate a significant association between self-reported levels of distress and restraint and prior criminal behavior as well as behavior during incarceration. Furthermore, of the sample surveyed, 67% were rearrested. Personality traits measured during incarceration were predictive of recidivism rates, above and beyond the effects of such criminological factors as age and number of prior offenses. The results support the view that juvenile delinquents are a heterogeneous population in terms of personality features. These traits have discriminant and predictive validity. Adding personality measures to the assessment of delinquents may further our understanding of how personality influences criminal activity and future recidivism. We may be able to use this understanding to target specific domains of functioning to develop more effective intervention strategies.