ArticleLiterature Review

Mental Disorders Among Adolescents in Juvenile Detention and Correctional Facilities: A Systematic Review and Metaregression Analysis of 25 Surveys

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Abstract

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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... This is similar to other studies from other African countries 14,19,23 and other parts of the world. 17,24 The prevalence of conduct disorder in this study was similar to that obtained by Wasserman et al. 25 amongst 292 male youths in secure facilities in the USA. McCabe et al. 26 also found a prevalence of 33% amongst adjudicated male youths. ...
... 19 A meta-analysis of 25 surveys found a prevalence rate of 3.3% and 2.7% of psychotic disorders for incarcerated adolescent boys and girls, respectively. 24 McManus et al. 25 reported a prevalence rate of 18% for psychotic disorders and a study of incarcerated boys in the Netherlands reported that 34% of their participants were DISC-2.3 psychosis screen positive. ...
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BACKGROUND: The high occurrence of psychiatric disorders amongst adolescents within the Juvenile Justice System (JJS) has been confirmed. Most of the available data are from developed countries and some of them focus on just a single psychiatric disorder which may not be representative of the situation in low-income countries, hence the need for more studies in developing countries, including Nigeria. AIM: The study aimed to determine the prevalence of psychiatric disorders amongst adolescent residents of a correctional facility. SETTING: The study was carried out at a Borstal Institution in North-Central Nigeria. METHODS: A descriptive cross-sectional study design was used. One hundred and twenty adolescents were assessed using the socio-demographic pro forma questionnaire designed by the researcher and the Kiddies Schedule for Affective Disorders and Schizophrenia (KSADS-PL). Data were analysed using EPI-INFO 4.06 d version 6.04 software. RESULTS: A total of 62.5% of the male respondents were older than 15 years. The percentage of respondents with a psychiatric disorder was 82.5%. The rate of psychiatric disorders was high with disruptive behaviour disorders being the most common at 40.8%, others were substance use disorders (15.8%), anxiety disorders (14.2%), psychosis (6.7%) and mood disorders (5%). CONCLUSION: This study has established a high prevalence rate of psychiatric disorders amongst incarcerated adolescents. This is in line with the findings of numerous studies worldwide. This study has identified the need to increase awareness and knowledge about the high morbidity of mental disorders in growing juvenile detainee populations. This will allow early identification of adolescents at risk of psychiatric disorders and ensure efficient resource distribution of both JJS service and mental healthcare. Effective and appropriate interventions have shown to improve overall health, quality of life and reduce the rate of recidivism amongst incarcerated juveniles.
... High levels of mental health problems are common among adolescents in juvenile justice institutions (Colins et al., 2010;Fazel et al., 2008;Van Damme et al., 2014;Vermeiren et al., 2006). These mental disorders are mostly situated within the externalizing spectrum, including attentiondeficit/hyperactivity, disruptive (conduct, oppositional defiant), and substance use disorders (Van Damme et al., 2014), although high rates of internalizing problem behaviors such as anxiety and depression are also well documented (e.g., Colins et al., 2010;Teplin et al., 2002;Van Damme et al., 2014;Vermeiren et al., 2006). ...
Article
The present study investigates the often observed higher scores on psychopathology in detained girls compared to boys from a maladaptive trait perspective, as conceived by age-specific criterion B assessment of the Alternative Model of Personality Disorders. Participants were detained youth (N = 237; 122 boys; 115 girls, mean age = 15.8 years) from two youth detention centers in Belgium, who completed self-reports on maladaptive traits and psychopathology. Results confirm that the higher rates of psychopathology in incarcerated girls extend to the maladaptive trait level, with particularly higher levels of Emotional Instability and Oddity. In addition, a stronger co-occurrence of psychopathology with maladaptive traits was found for girls, especially for anxious-depressed, angry-irritable, and post-traumatic symptoms. These findings suggest that mental health problems in detained girls appear to be much more related to personality difficulties compared to detained boys, and advocate the inclusion of comprehensive maladaptive trait assessment and gender-sensitive intervention programs for mental health problems in detained youth.
... Children in secure residential care often present a danger to themselves (e.g., substance use, psychiatric problems, behavioural problems, refusing education) or others (e.g., aggression, criminal behaviour) (Anckarsäter et al., 2007;Colins et al., 2010;Fazel et al., 2008;Leloux-Opmeer et al., 2016). They often refuse any form of compulsory treatment and may react aggressively ( Van der Helm et al., 2011a). ...
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This study examines the extent to which secure residential youth care in the Netherlands complies with children’s rights as laid down in the United Nations Convention on the Rights of the Child ( uncrc ) and the Dutch Youth Act. Residential group climate was measured with the Prison Group Climate Instrument ( pgci ), which assesses quality of group care from the perspective of the three basic needs for human self-determination: contact, autonomy and competence. Results indicate that children’s rights are a subsidiary issue in secure residential youth care in The Netherlands, because groups workers and staff have insufficient understanding of children’s rights and Dutch legislation on youth care. Dutch law allows secure facilities to make their own policy on youth care delivery, but it seems that policies are insufficiently explicit about children’s rights. Results of this study can be used to work on the fulfilment of children’s rights in secure residential youth care.
... Kelompok remaja yang berada dalam latar belakang sistem keadilan Juvenil iaitu remaja delinkuen yang menerima tahanan dan di bawah pemulihan akhlak didapati menderita masalah kemurungan 10 kali ganda lebih tinggi daripada keseluruhan populasi remaja (Fazel et al., 2008). Namun demikian masalah ini sering diabaikan walaupun ia merupakan satu isu besar kepada kumpulan ini. ...
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Delinquent adolescents with depressive disorder have a higher number than the general adolescent population. Depression is associated with negative behavior and moral misconduct that can endanger themselves and society. Thus, this study aims to identify the effectiveness of the Rational Emotive Behavioral Therapy (REBT) module in overcoming depression among delinquent adolescents. This study involved a total of 100 adolescents age between 15 to 20 who were detained under the juvenile justice system at Sekolah Tunas Bakti (STB), Federal Territory of Kuala Lumpur. All respondents were selected using simple random sampling and divided into two groups, namely the treatment group (n = 50) who received therapy using the REBT module, and the control group (n = 50) who were not given the same therapy. ANCOVA repeated measure was used to identify the significant changes in depression score between groups. The results of the analysis showed that there were significant differences between groups. Adolescents who were received therapy using the REBT module showed lower depression scores than adolescents from the control group. This study provides an important finding as an alternative intervention therapy to be used by the therapists and the trainers at the juvenile rehabilitation center in promoting adolescents’ positive emotions.
... It is shown by more frequent absences of a biological parent, more frequent imprisonments of household members, and less frequent resort to care services by families, while psychiatric disorders are more frequent in CEC adolescents. Although the reported data concerning adolescents with radicalised AMT are unique, those on adolescents with CEC are consistent with international reported data, as many studies report high rates of psychiatric disorders, especially conduct disorders (37,38). We also find very high rates (up to 90%) of imprisoned adolescents with a large predominance of externalised disorders, in particular conduct disorders (39). ...
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Since 2010 and the founding of the Islamic State, the radicalisation phenomenon in Europe has involved more adolescents and converts to Islam than in previous Islamist terrorist group movements (e.g., Al-Qaeda). In most cases, these adolescents are “homegrown terrorists,” a challenging difference, as they are in confrontation with their home and societal environment. As a new and emerging phenomenon, radicalisation leads to many questions. Are empathic capacities altered? Are they presenting psychiatric pathologies or suicidal tendencies that explain why they put themselves in serious dangers? Are they just young delinquents who simply met a radical ideology? In January 2018, by special Justice Department authorisation, we contacted all minors ( N = 31) convicted in France for “criminal association to commit terrorism.” We assessed several sociodemographic, clinical and psychological variables, including empathy and suicidality, in half of them ( N = 15) and compared them with 101 teenagers convicted for non-terrorist delinquency who were placed in Closed Educational Centres (CEC). The results show that adolescents engaged in radicalisation and terrorism do not have a significant prevalence of psychiatric disorders, suicidal tendencies or lack of empathy. It also appears that they have different psychological profiles than delinquent adolescents. “Radicalised” adolescents show better intellectual skills, insight capacities and coping strategies. In addition, the manifestation of their difficulties is less externalised than adolescents from the CEC, having committed very few delinquent acts.
... Contudo, não foi identificado uma ação específica no ML para o alcance desse objetivo. É importante considerar que as demandas de saúde mental são identificadas como uma das principais demandas de saúde nessa população [29][30][31][32][33][34][35][36] . ...
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Resumo Trata-se de estudo descritivo e exploratório, utilizando de análise documental, aplicação de questionário e de grupo focal para elaboração e validação de modelo lógico da teoria da Política Nacional de Atenção Integral à Saúde de Adolescentes em Atendimento Socioeducativo (Pnaisari), que vem sendo implementada com o objetivo de garantir o acesso aos cuidados em saúde para essa população. Dessa forma, o objetivo do presente estudo é descrever as etapas de desenvolvimento e os resultados do processo de elaboração e validação do modelo lógico da Pnaisari. Como resultados, o modelo lógico validado exaltou a articulação intersetorial e interfederativa como elemento central e fundamental para a implementação da política. Como forma de aperfeiçoamento do modelo, recomenda-se inserir os insumos envolvidos nas ações, evidenciar as ações de saúde mental, descrever os atores envolvidos nas etapas, além da organização dos produtos e resultados em metas tangíveis, separando o que é resultado do que é impacto. Apesar de todos os desafios na implementação, os objetivos e diretrizes da política devem ser realizadas por todos os municípios do país, considerando que a Pnaisari é a política do Sistema Único de Saúde para os adolescentes privados de liberdade.
... Youth involved in the juvenile justice system experience high rates of mental health problems and trauma (91)(92)(93). Approximately 65% of justice-involved youth meet criteria for a mental health disorder, compared to 10-25% of youth in the general population (92). ...
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Various biological, social, psychological, and environmental factors impact children and youth living with mental health problems across their lifespan. To meet the wide-ranging challenges of mental illness, service system integration is needed to improve efficiencies and reduce fragmentation. Unfortunately, the mental health system has been plagued by the lack of coordination across services. There is a general consensus that mental health service delivery must ensure a child or youth’s needs are addressed in a collaborative, coordinated, and seamless manner. A key element to successful integration is the development of a comprehensive standardized screening and assessment system. Numerous assessments have been developed to assess child mental health and functioning, but they typically have a very narrow focus with limited use and utility. Not only does this reduce the ability to take a life course perspective to mental health, but this uncoordinated approach also results in redundancies in information collected, additional resources, and increased assessor burden for children, youth, and their families. The interRAI child and youth mental health assessment suite was developed in response to the need for an integrated mental health system for young persons. This suite includes screening and assessment instruments for in-patient and community settings, emergency departments, educational settings, and youth justice custodial facilities. The instruments form a mental health information system intentionally designed to work in an integrated fashion beginning in infancy, and incorporate key applications such as care planning, outcome measurement, resource allocation, and quality improvement. The design of these assessment tools and their psychometric properties are reviewed. Data is then presented using examples related to interpersonal trauma, illustrating the use and utility of the integrated suite, along with the various applications of these assessment systems.
... An essential role of suicide prevention is the identification of mental disorders and their prompt and competent treatment [45]. This applies in particular to suicide prevention among prisoners [31], since mental disorders, including affective disorders, ADHD, personality disorders, alcohol and drug abuse, prior maltreatment, and suicide attempts are highly prevalent in this population [32,[46][47][48][49][50]. Even before intake, prisoners show a high prevalence of previous suicide attempts or drug withdrawal treatment [51]. ...
... In addition to PTSD, justice-involved youth may suffer additional adverse mental health problems because of trauma exposure. In their meta-analysis of 16,750 youths, Fazel et al., (2008) found that mental illnesses were substantially more common in detained youth than the general adolescent population, with rates of depression four to five times more common in justice-involved girls and twice as common in boys. Detained youth with PTSD have been shown to be more likely to have a comorbid mental illness than youth without PTSD (Abram et al., 2007), and there is evidence that PTSD mediates the relationship between trauma and mental health problems such as depression and drug use (Kerig et al., 2009). ...
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Research documents trauma experiences and Post-Traumatic Stress Disorder (PTSD) among juvenile justice-involved youth; however, much less is known about the trauma and PTSD of their parents. This manuscript examines the extent to which youth PTSD and parent PTSD relate to youth’s mental health problems (e.g., anxiety, depression), emotional regulation, and drug use. Data are from a baseline sample of 149 youth-parent dyads recruited from the Los Angeles County Juvenile Court System to participate in an efficacy trial of EXPORT/STRIVE, a family-based intervention administered to both youth and their parents or guardians. The intervention aimed to reduce individual and interpersonal challenges youth report experiencing when leaving incarcerated settings. We compared youth’s mental health problems, emotional regulation, and drug use between youth with and without PTSD, as well as between youth with parents with PTSD and without PTSD. Results illustrate a high rate of exposure to traumatic events among both youth and parents, and significant associations between youth mental health problems and emotional regulation with youth PTSD but not parental PTSD. While parental PTSD was not directly associated with youth’s problems, given such high rates of trauma and PTSD among parents of juvenile justice-involved youth, family interventions targeting juvenile justice-involved youth should more intentionally consider the potential role parental trauma might play in intervention engagement and effectiveness.
... Le trouble de stress post-traumatique n' est pas relevé dans les méta-analyses bien qu'un surcroît d' expositions à la violence, autant comme agresseur, témoin ou victime, laisse inévitablement des traumatismes. En diminuant le contrôle des impulsions agressives (Steiner et al., 1997, cités dans Laurier & Morin, 2014, ce trouble pourrait être lié aux troubles de conduite, troubles psychiatriques les plus fréquents chez les JC-MGR en établissement (Fazel et al., 2008, cités dans Laurier & Morin, 2014. Or, les interventions seraient plus efficaces si les troubles intériorisés, en particulier les traumas, étaient aussi considérés (Laurier & Morin, 2014). ...
Article
RÉSUMÉ Cette étude expose une analyse phénoménologique de 16 textes écrits lors d’un projet de disque de raps et d’un atelier d’écriture de slams par les membres de gang de rue en centre jeunesse à Montréal. Peu loquaces en thérapie, nous avons cherché ce que ces jeunes y ont dévoilé de leur vécu, afin d’éclairer leur parole et de fournir une validation supplémentaire du dispositif en contexte thérapeutique chez cette population. Nos résultats démontrent la validité du rap et du slam pour libérer leur expression, en plus de leur pertinence pour aborder les enjeux mis en lumière, notamment l’insécurité possiblement liée au trauma et le désespoir découlant d’un milieu manquant de ressources. D’autres études seraient nécessaires afin d’approfondir les connaissances sur les troubles intériorisés de ces jeunes, ainsi que sur le vécu ambivalent de leur prise en charge.
... Adolescents may be primed for involvement with crime considering their heightened desire for sensation-seeking in conjunction with their underdeveloped sense of self-regulation (Steinberg, 2017). Studies have shown that youth engaging in criminal behavior have a more challenging time self-regulating; in particular, they are often impulsive and show impaired behavioral and cognitive flexibility (Fazel et al., 2008;Vitacco & Kosson, 2010). In addition, adolescents are more susceptible to peer pressure than adults. ...
Article
The youth corrections system is in need of reform. Emerging work from the field of positive criminology is working to shift the focus from retribution and risk management to strengths building and positive youth development. Research suggests, targeted strategies from positive psychology can provide youth with opportunities to counteract the potentially deleterious effects of incarceration, especially as adolescent neurobehavioral development offers a ripe opportunity for positive interventions that enhance wellbeing. Strengths-based compassion, the proposed positive intervention described within, uses mindfulness, character strengths, and the cultivation of compassion to improve self-regulation and self-discipline, increase self-esteem, improve social skills, and reduce recidivism. The proposed eight-week program is designed through a trauma-responsive lens that has been adapted for youth in a correctional facility and creates the potential for revolutionary change in the hearts and minds of young offenders. This change positions youth on a productive path in which they desist from future criminal activity and increase pathways for flourishing in their lives after incarceration.
... Beyond trauma, the high percentage of youth who are incarcerated with mental disorders is well documented. Compared to youth in the community, youth who are incarcerated have higher rates of substance use disorder (McClelland et al., 2004), conduct disorder (Shufelt & Cocozza, 2006), attention-deficit/hyperactivity disorder (Fazel et al., 2008), anxiety disorder (Wasserman et al., 2005), and depression (Weiss & Garber, 2003). In fact, as many as 70% of youth who are incarcerated have a mental disorder (Shufelt & Cocozza). ...
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To promote the safety and well-being of youth who are incarcerated, the U.S. Departments of Justice and Education identified the importance of evidence-based mental health interventions. The purpose of this systematic review is to summarize and synthesize intervention research focusing on the mental health of youth who are incarcerated since the publication of Guiding Principles for Providing High-Quality Education in Juvenile Justice Secure Care Settings. ProQuest and Ebsco databases were searched to identify relevant published studies from 2015 to 2020. Eleven studies met the inclusion criteria. Studies mainly focused on cognitive-behavior interventions and included the following outcome domains: symptoms, functioning, personal growth, and multiple domains. To evaluate study quality, modified versions of Gersten et al.'s (2005) group design and Mulcahy et al.'s (2016) single-case design quality indicators were used. Of concern are the small number of studies, methodological limitations within studies, and lack of a common intervention and outcomes of focus that limit individual study conclusions and evaluation across studies. In particular, studies rarely included necessary information, such as participant mental health characteristics, interventionist training or qualifications, intervention details, and/or measures/reports of treatment integrity. For the Guiding Principles to be realized, one key issue is for government funding to target high-quality mental health interventions in juvenile correctional facilities within identified target areas. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Children and adolescents in the child welfare system experience high levels of cumulative familial and psychosocial burden such as maltreatment, mental health issues, delinquent behavior, and low socioeconomic status [1][2][3]. Youths in the juvenile justice system are marked by similarly elevated rates of family dysfunction, psychopathology, and other psychosocial burdens [4,5]. These burdens can elevate the risk of chronic mental health issues and other psychosocial difficulties into adulthood [6,7]. ...
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Background: Child welfare and juvenile justice placed youths show high levels of psychosocial burden and high rates of mental disorders. It remains unclear how mental disorders develop into adulthood in these populations. The aim was to present the rates of mental disorders in adolescence and adulthood in child welfare and juvenile justice samples and to examine their mental health trajectories from adolescence into adulthood. Methods: Seventy adolescents in shared residential care, placed by child welfare (n = 52, mean age = 15 years) or juvenile justice (n = 18, mean age = 17 years) authorities, were followed up into adulthood (child welfare: mean age = 25 years; juvenile justice: mean age = 27 years). Mental disorders were assessed based on the International Classification of Diseases 10th Revision diagnoses at baseline and at follow-up. Epidemiological information on mental disorders was presented for each group. Bivariate correlations and structural equation modeling for the relationship of mental disorders were performed. Results: In the total sample, prevalence rates of 73% and 86% for any mental disorder were found in adolescence (child welfare: 70%; juvenile justice: 83%) and adulthood (child welfare: 83%; juvenile justice: 94%) respectively. General psychopathology was found to be stable from adolescence into adulthood in both samples. Conclusions: Our findings showed high prevalence rates and a high stability of general psychopathology into adulthood among child welfare and juvenile justice adolescents in Swiss residential care. Therefore, continuity of mental health care and well-prepared transitions into adulthood for such individuals is highly warranted.
... An essential role of suicide prevention is the identification of mental disorders and their prompt and competent treatment [45]. This applies in particular to suicide prevention among prisoners [31], since mental disorders, including affective disorders, ADHD, personality disorders, alcohol and drug abuse, prior maltreatment, and suicide attempts are highly prevalent in this population [32,[46][47][48][49][50]. Even before intake, prisoners show a high prevalence of previous suicide attempts or drug withdrawal treatment [51]. ...
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Objective Prisoners constitute a high-risk group for suicide, with suicide rates about 5 to 8 times higher than in the general population. The first weeks of imprisonment are a particularly vulnerable time, but there is limited knowledge about the risk factors for either early or late suicide events. Methods Based on a national total sample of prison suicides in Germany between 2005 and 2017, suicides within the first 2 (4 and 8) weeks after reception into prison were matched by age and penalty length with cases that occurred later. Factors that potentially influence the timing of suicide were investigated. Results The study has shown that 16.7% (31.5%) of all 390 suicides in German prisons occurred within the first two weeks (two months) of imprisonment. Factors that facilitate adaptation to the prison environment (e.g. prior prison experience) were negatively associated with early suicide events. Factors that hindered the adaptation process (e.g. withdrawal from illicit drugs) were observed more frequently in early suicide events than in late ones. These factors are active at different times of imprisonment. Conclusion At reception, particular attention should be paid to the following factors associated with early suicide events: widowed marital status, lack of prison experience, and drug dependency.
... At this point, it is worth noting that the relationship between offending behavior and psychopathology is complex (Grisso, 2008). The percentage of youth with mental health needs in the juvenile justice system is higher than in the community and seems to be increasing (Fazel et al., 2008). However, this percentage should not be explained in terms of a causal relationship but rather as a spurious one in which exposure to adverse childhood experiences plays a central role (Colins & Grisso, 2019). ...
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Objectives: This study contributes to the neuroscience of offending behavior by addressing two aims: a) to examine differences in the cortical features in a group of male serious juvenile offenders (21 OG), versus controls (28 CG), both ranging from 18 to 21 years old; and b) to determine to what extent the differential cortical features and the risk psychological profile discriminate between the two groups. Method: Besides cortical measures, demographics, executive functioning, childhood trauma, psychopathic traits, psychopathological symptoms, and antisocial and delinquent behavior were assessed. Results: Whole-brain analysis of the cortical mantle identified increased cortical thickness in the cluster comprising the right middle temporal gyrus and a smaller surface area in the lateral orbitofrontal cortex for the OG compared to the CG. The discriminant function correctly classified 100% of cases of the CG and 94.7% of the OG. Right temporal cluster, childhood trauma, callousness and symptoms of interpersonal sensitivity, psychoticism, depression, phobic anxiety, and obsessive-compulsive behavior contributed to the OG. In turn, the lateral orbitofrontal cluster, psychopathic traits of grandiosity, unemotionality, and thrill seeking, and working memory contributed to the CG. Conclusions: The increased right middle temporal gyrus of the OG could be indicative of impaired brain development in social cognition processes since it appeared in combination with the higher risk profile. The reduced orbitofrontal cortex could be indicative of immature brain development in emotional control processes since it appeared in combination with the normative psychological profile in adolescence. Based on these novel findings, areas of potential improvement for research and intervention are suggested.
... In model 2, the register-based follow-up information on the use of psychotropic medication (ATC groups for opioids, antiepileptic drugs, benzodiazepines, sleeping medications, stimulants, drugs for treating addictions, antidepressants, antipsychotics, and other psychotropic medications), gender and age at the end of the follow-up data for psychotropic medications in year 2012 were analysed as potential predictors for drug crime offending. Model 3 used all variables included in model 1 and 2. The choice of variables for the statistical modelling was based on evidence-based knowledge of factors known to be related to offending according to published literature (Fazel et al., 2008;Hensel et al., 2020;Moore et al., 2019) and whether they were available in our database. All analyses were two-tailed, and a limit of statistical significance was set at p < 0.05. ...
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Background: Various psychotropic prescription drugs are known to have potential for misuse. Among teenagers, non-medical use of prescription drugs may predate illicit drug use or occur concomitantly. Aims: Our aim was to examine prescriptions of psychotropic medications among drug crime offenders and non-criminal controls in a psychiatric inpatient cohort of 13-17-year-olds. Our research question was: were prescribed psychotropic and potentially addictive drugs associated with later drug crime offending. Methods: Our sample was of all 60 adolescents who had been convicted of a drug crime by young adulthood with a twice-sized control group, matched for gender, age and family-type, from a cohort of 508 adolescents consecutively admitted to a psychiatric inpatient care in Finland between April 2001 and March 2006. Adolescence-related information on substance use and psychiatric disorders was obtained by semi-structured interviews. Follow-up information on crimes and medication purchases was obtained from Finnish nationwide registers. The association of studied factors to drug crime offending was examined using stepwise binary logistic regression analysis. Results: 75% of drug crime offenders and 47% of non-criminal controls had used addictive psychotropic medications during the follow-up period (p < 0.001). 74% of all drug crime offenders' purchases of prescribed addictive drugs occurred within the year preceding drug crimes. Of addictive drugs, the use of clonazepam and gabapentinoids was most likely to associate with drug crime offending (AOR 7.77, p < 0.001). Conduct and substance use disorders diagnosed in adolescence (AOR 3.49, p = 0.010; AOR 2.34, p = 0.050) were predictors for drug crime offending. Conclusions: Our findings suggest that, when treating young adults with conduct disorder and a history of substance use, physicians should prescribe addictive medications with caution, favouring instead non-addictive medications complemented by psychosocial interventions.
... International studies (e.g., Desai et al., 2006;Fazel, Doll, and Långström, 2008;Gretton and Clift, 2011;Grigorenko, Edwards, and Chapman, 2015;Livanou, Furtado, Winsper, Silvester, and Singh, 2019;Penner, Roesch, and Viljoen, 2011;Schubert, Mulvey, and Glasheen, 2011;Steiner, Garcia, and Mathews, 1997;Teplin, Abram, McClelland, Dulcan, and Mericle, 2002;Teplin, Welty, Abram, Dulcan, and Washburn, 2012) have identified a substantial proportion of psychological problems in institutionalized juvenile offenders. Depression, anxiety, and substance abuse are among the most frequently reported disorders. ...
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Introduction One of the most serious socio-educational measures for children and adolescents in conflict with the law in Brazil is their internment. This measure may represent an additional source of stress to this population and present significant impacts in the mental health context. This study aims to describe anxiety levels, depression, and addictive consumption, as well as to estimate the causalities and interactions of these variables. Methods Herein, we report a study in which 175 male juveniles from youth detention institutions of the Federal District voluntarily completed the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and a short self-rating questionnaire asking whether and how often they had experienced cannabis, alcohol, and other “hard” psychotropic drugs (e.g., crack, cocaine, amphetamine) 1 year prior to institutionalization. Results Of the total participants, 28.00% showed moderate to severe depression scores and 34.28% showed moderate to severe anxiety scores. In addition, the vast majority of participants also reported some antecedent drug abuse, including cannabis, alcohol, and other “hard drugs.” The BDI scores moderately correlated with BAI, but none of these parameters considerably correlated with the antecedent drug abuse. Conclusions The data indicate potentially concerning levels of emotional distress in these institutionalized juveniles which seem to be independent of addictive behaviors. These data deserve attention and further investigation. Thus, a need for preventative mental health for the general population and socio-educational intervention aimed at interned youth which can decrease levels of emotional stress is emphasized.
Article
This study examines associations between recidivism rates and groups/programs for legally mandated education, behavioral, and mental health services that court-ordered juvenile youth (“juveniles”) with identified Emotional Disturbance or related conditions receive in secure-care juvenile facilities. Using statewide agency data in Minnesota, this exploratory analysis investigates whether there are racial/ethnic and county disparities in residential placements or secure-care settings via programs and groups for court-ordered juveniles ( n = 1,092). The study also considers whether program and group placements contribute to racial/ethnic patterns of recidivism. This study finds that recidivism rate differences by program/group level are largely attributed to differences in racial/ethnic compositions. Findings suggest placements lack strong effects on recidivism, and assignments may perpetuate inequalities. In addition, from this exploratory analysis examination, this article offers considerations for future research-to-practice partnerships to strengthen legally and policy-mandated program and service delivery with practices that increase training to juvenile justice system professionals, access to secure-care setting services, and transition services for juveniles.
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Youth with emotional and behavioural disorders (EBD) are guaranteed the same right to inclusive education as other students with and without disabilities. While Finland and the United States (U.S.) are committed to the ideals of inclusion, evidence suggests that these students are often excluded. This paper discusses Finnish and U.S policies and practices that identify and ‘push out’ youth with EBD. Additionally, the quality of education in exclusive settings, including Finnish reform schools, U.S. alternative schools and day treatment/residential psychiatric facility schools, as well as (juvenile) correctional facilities in both countries, are discussed. Recommendations are provided for policy and practice that will promote access to inclusive education for these troubled youth.
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Purpose Recent literature has pointed out the seriously unmet treatment needs of delinquent youth with mental health problems in Hong Kong. This study pioneers to systematically develop and evaluate the effectiveness of a structured low-intensity cognitive behavioral intervention (LICBI) to concurrently address mental health issues and delinquent behaviors among Hong Kong Chinese youth. Method A quasi-experimental controlled design was adopted with three assessments at baseline, postintervention, and 6-week follow-up. One hundred and eighty participants were recruited to the LICBI and 123 to the control group. Results Multilevel modeling analyses showed that the LICBI might be effective in improving mental health–related factors (impulsivity, self-esteem, negative emotions, and loneliness) and delinquent behaviors. A mediation analysis suggested that LICBI might reduce participants’ delinquent behaviors through reducing their impulsivity and enhancing their self-esteem. Discussion The results provide preliminary evidence for the effectiveness of LICBI for Chinese delinquent youth in a community social service setting.
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Purpose: This systematic review and meta-analysis estimates the overall language skills of youth offenders involved with the juvenile justice system. Given the importance of this population, identifying avenues through which we can increase the likelihood of successful interventions is a necessary societal effort. Method: Eighteen studies, representing data from 3304 individuals, contributed 82 effect sizes to the current analytic sample. We used random-effects models to estimate the overall mean effect size metric to address each research question, and fit meta-regression models for each moderator analysis. Results: Results yielded that youth offenders presented with significantly lower language skills than their non-offending peers (g=-1.26). Further, high proportions of the present meta-analytic sample were classified as youth with moderate (50%) and severe (10%) language disorders. In general, differences in language skills did not vary as a function of age, gender, or language measure type. We did detect significant differences as a function of sample country and type of peer comparison group. Conclusion: This meta-analysis reports on the significantly compromised language skills of youth offenders. We conclude with a discussion of the findings and consideration of the implications for research and practice.
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Many people with severe mental health problems experience imprisonment at some point in life. Most mental disorders are more prevalent in imprisoned populations compared to general populations. The following chapter addresses the prevalence of mental health and substance use disorders in prison populations, screening instruments and treatment approaches. The incidence of suicide and prevention interventions are outlined for the prison context. Challenges for care resulting from high levels of comorbidity and specificities of the prison context are reviewed. Routine screening and treatments need to be scaled. More prevention and treatment intervention trials in prison populations are needed, since evidence is scarce and not necessarily transferrable from community settings.
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There is limited understanding of mental health service utilization among youth in the juvenile justice system (JJS). Using administrative data, the current study examined service system trajectories of two cohorts of youth who initially entered the JJS in 2003 (N = 10,170) and 2012 (N = 5,787). We tracked mental health (MH) service utilization and dosage and child welfare system (CWS) involvement for 3 years and found that utilization and dosage of MH services increased between both cohorts. Notably, MH service use positively associated with CWS involvement and concurrent (dual) involvement in the CWS and JJS associated with decreased MH dosage if youth remained at home versus being placed in out-of-home care. Lastly, African American children received less services than their Caucasian peers. Future efforts should focus on preparing MH providers to detect youth who are dually involved and tailor services to enhance collaboration and information sharing across systems.
Article
Psychologists in the helping professions have long accepted the idea that cognitions have implications for mental health and wellbeing. Community psychologists have further established the importance of context and systems in the etiology of mental health problems. In this paper, we argue that as a discipline that prioritizes social justice, community psychology should consider associations between cognitions about structural and systemic inequality and individual mental health, particularly in marginalized populations. As one illustration of this argument and its complexities, we asked if and to what degree mental health was concurrently associated with adolescents' beliefs in societal fairness (i.e., system-justifying beliefs), attending to gender differences. Our findings were informed by a sample of 196 adolescents residing in detention facilities (49.50% girls; 51.75% Black/Caribbean, 21.68% multiracial; 15.38% Hispanic/Latine; 27.98% LGBTQ+). These youth represent an understudied group in the research literature addressing fairness beliefs and their influence on wellness. Results suggested that boys were more likely to endorse societal fairness compared to girls, but these beliefs were unrelated to their mental health. However, we found a significant gender moderation such that girls who perceived society to be fair reported lower levels of internalizing and externalizing mental health problems. We discuss implications for theory, research, and intervention. Highlights • We suggest that youths' cognitions about social systems may be associated with their mental health. • This study examines these associations in a sample of youth in detention. • Believing society to be fair was associated with fewer mental health problems for girls. • There were no associations between mental health and fairness beliefs for boys.
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Importance In adulthood and adolescence, mental health vulnerability is known to be associated with risk of criminal justice system contact as both a perpetrator and survivor of crime, but whether this association is apparent early in child development is unknown. Prevention of poor outcomes, including repeated contact with the criminal justice system, relies on the identification of vulnerability early in life and at the start of such contact. Objective To ascertain whether children with emotional or behavioral problems and general developmental vulnerabilities are at an increased risk of subsequent contact with police as a person of interest, a survivor of crime, or a witness. Design, Setting, and Participants This cohort study used routinely collected data from the New South Wales Child Development Study in Australia. The cohort was composed of children who entered full-time schooling in New South Wales in 2009, had complete data for the emotional maturity domain of the Australian Early Development Census, and had no police contact before January 1, 2009. The children in the cohort were followed up until the age of 13 years. Data were analyzed from October 17, 2019, to May 13, 2020. Exposures Emotional or behavioral problems and developmental risk profiles derived from the teacher-rated Australian Early Development Census. Main Outcomes and Measures Incidence rates of police contact (as a person of interest, survivor of crime, or witness) were derived from the New South Wales Police Force Computerised Operational Policing System. Results A total of 79 801 children (40 584 boys [50.9%]; 2009 mean [SD] age, 5.2 [0.37] years) were included. Children with teacher-identified emotional or behavioral problems at school entry had an incidence rate of police contact (for any reason) that was twice that of children without such problems (unadjusted hazard ratio [HR], 2.14; 95% CI, 1.94-2.37). Contact with police as a survivor of crime was most commonly recorded (7350 [9.2%]), but the strength of the association was greatest between emotional or behavioral problems and police contact as a person of interest (unadjusted HR, 4.75; 95% CI, 3.64-6.19). Incidence of police contact as a person of interest was high for children with a pervasive developmental risk profile (unadjusted HR, 13.80; 95% CI, 9.79-19.45). Conclusions and Relevance This study found an association of emerging emotional or behavioral problems and developmental vulnerabilities with increased risk of police contact for any reason among young children, suggesting that this well-known association in adults and adolescents can be identified at an earlier developmental stage. These findings support primary and secondary interventions to prevent police contact early in life and to target the earliest contacts with the criminal justice and educational systems.
Article
Objective: Justice-involved youth report high rates of adverse childhood experiences (ACEs; abuse, neglect, household dysfunction) and are at high risk for elevated behavioral health needs (i.e., substance use, psychiatric symptoms). Research with broad samples of adolescents shows ACEs predict behavioral health outcomes, yet most research on the impact of ACEs among justice-involved youth focuses on recidivism. The present study addresses this gap by examining the prospective association between ACEs and psychiatric symptoms, substance use, and substance-related problems (i.e., consequences of use) among first-time justice-involved youth. Method: First-time justice-involved youth (n = 271; 54.3% male; M age = 14.5 years; 43.5% Latinx; non-Latinx: 34.2% White, 8.6% Black, 7.1% Other, 6.7% Multiracial) and their caregivers were assessed at youth's first court contact and 4- and 12-month follow-ups. Youth and caregivers reported youth's exposure to ACEs through a series of instruments at baseline and 4-months (e.g., Childhood Trauma Questionnaire Short-Form; Traumatic Life Events Inventory). Primary outcomes included youth alcohol and cannabis use (Adolescent Risk Behavior Assessment), consequences of use (Brief Young Adult Alcohol Consequences Questionnaire; Brief Marijuana Consequences Scale), and psychiatric symptoms (Behavior Assessment System for Children; National Stressful Events Survey PTSD Short Scale). Results: Youth were exposed to three ACEs, on average, prior to first justice contact (M = 3). Exposure to more ACEs, particularly abuse, predicted substance use and psychiatric outcomes. Gender differences emerged for cannabis use and internalizing symptoms. Conclusions: Implications for trauma-responsive juvenile justice reform are discussed, including screening for ACEs and their sequelae at first court contact and considering the role of masculine norms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Background: Incarceration and mental health problems are known to have a strong empirical association. Many studies have confirmed the high prevalence of mental health problems among young prisoners in particular, yet none has been conducted in Cambodia. Objectives: this study aimed to assess the level of mental health problems and suicidal expressions, and determine the associated risk factors among young prisoners in Cambodia. Method: this was a cross-sectional study among 572 young prisoners between the ages of 15 and 24 from three prisons. Sociodemographic data and detailed information on participants' profiles were gathered, and mental health problems and suicidal expressions were assessed using the Youth Self-Report (YSR) and the Attitude Towards Suicide (ATTS) questionnaires, respectively. Results: Mental health problems as revealed by the mean YSR scores were: 25.97 for internalizing and 18.12 for externalizing problems; 11.88 for anxiety/depression, 9.97 for aggressive behaviours and 7.53 for somatic complaints. Social problems, attention problems and rule breaking behaviour were in the range of 8.10 to 8.49. Withdrawal depression and thought problems mean scores were 6.55 and 6.66, respectively. Mental health problems were associated with younger age, lower educational background, and shorter duration of incarceration. Around 16% had thought about their own death, and 12% expressed wish to die. Suicide ideation, planning, and attempts were reported by almost 7%, 2%, and 3% of participants respectively. Prior drugs users thought about death significantly more than their counterparts while suicide ideation was significantly lower among prisoners with higher education. Conclusion: Mental health problems and suicidal expressions among young prisoners warrant well-planned mental health services that are integrated into the current prison health system. A contextualised intervention that takes into account age, education, duration of incarceration and previous drug use may contribute to improve the mental well-being of young prisoners in Cambodia.
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Background The system of secure care for young people in England and Wales comprises youth justice, welfare and mental health facilities. Empirical studies have failed to investigate the system as a whole. The National Adolescent Study in 2016 was the first to provide comprehensive system wide information. This paper, derived from that data set, addresses equity of service provision for young men and women in secure care who have mental health problems. Methods The detained census population of English young people in 2016 was 1322 and detailed data were available on 93% of this population, including 983 young men and 290 young women. The descriptive census data were interrogated to identify associations between gender, other sociodemographic and clinical variables, using Chi-square and Fisher’s exact tests. Results Numerically more young men in secure care than young women in secure care warrant a psychiatric diagnosis but young women had a 9 fold increase in the odds of having a diagnosis compared with the young men. The pattern of mental health diagnoses differed significantly by gender as did the legislative framework under which females and males were placed. This different pattern of secure care placement continued to differ by gender when the nature of the mental health diagnosis was taken into account. Conclusions No definitive explanation is evident for the significantly different placement patterns of young men and young women with the same mental health diagnoses, but the anticipated consequences for some, young men and some young women are important. Proper explanation demands an examination of process variables outwith the remit of this study. The lack of routine scrutiny and transparent processes across secure settings could be responsible for the development of these differential placement practices; these practices seem at odds with the duty placed on public services by the Equality Act.
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Background People who experience incarceration die by suicide at a higher rate than those who have no prior criminal justice system contact, but little is known about the effectiveness of interventions in other criminal justice settings. We aimed to synthesise evidence regarding the effectiveness of interventions to reduce suicide and suicide-related behaviours among people in contact with the criminal justice system. Methods We searched Embase, PsycINFO, MEDLINE, and grey literature databases for articles published between 1 January 2000 and 1 June 2021. The protocol was registered with PROSPERO (CRD42020185989). Findings Thirty-eight studies (36 primary research articles, two grey literature reports) met our inclusion criteria, 23 of which were conducted in adult custodial settings in high-income, Western countries. Four studies were randomised controlled trials. Two-thirds of studies (n=26, 68%) were assessed as medium quality, 11 (29%) were assessed as high quality, and one (3%) was assessed as low quality. Most had considerable methodological limitations and very few interventions had been rigorously evaluated; as such, drawing robust conclusions about the efficacy of interventions was difficult. Interpretation More high-quality evidence from criminal justice settings other than adult prisons, particularly from low- and middle-income countries, should be considered a priority for future research. Funding This work was funded by the Australian government's National Suicide Prevention Taskforce. RB is supported by a National Health and Medical Research Council (NHMRC) Emerging Leader Investigator Grant (EL2; GNT2008073). MW is supported by a NHMRC Postgraduate Scholarship (GNT1151103). SF was funded by the NIHR HTA Programme (HTA Project:16/159/09).
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Research suggests that convicted persons are more likely than non-convicted persons to suffer poor health. However, few longitudinal studies have investigated associations between health and offending across generations. Using the Cambridge Study in Delinquent Development, this article prospectively investigates the relationship between health and offending across generations and between genders. At the average age of 25, third generation convicted males and females reported a higher incidence of serious drug use than non-convicted persons. Convicted males reported a higher incidence of mental illness and self-harm, whereas convicted females reported a lower incidence of physical illness, mental illness, self-harm and hospitalizations when compared to non-convicted females. Convicted males reported a higher incidence of industrial accidents, sports injuries and fight injuries, but a lower incidence of road accidents, whereas convicted females were more likely to report road accidents. Like their fathers, convicted males show worse health compared to non-convicted individuals.
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Justice-involved youth (JIY) have high rates of behavioral health disorders, but few can access, much less complete, treatment in the community. Behavioral health treatment completion among JIY is poorly understood, even within treatment studies. Measurement, reporting, and rates of treatment completion vary across studies. This systematic review and meta-analysis synthesizes the literature on rates of treatment completion among JIY enrolled in research studies and identifies potential moderators. After systematically searching 6 electronic databases, data from 13 studies of 20 individual treatment groups were abstracted and coded. A meta-analysis examined individual prevalence estimates of treatment completion in research studies as well as moderator analyses. Prevalence effect sizes revealed high rates of treatment completion (pr = 82.6). However, analysis suggests a high likelihood that publication bias affected the results. Treatment groups that utilized family- or group-based treatment (pr = 87.8) were associated with higher rates of treatment completion compared to treatment groups utilizing individual treatment (pr = 61.1). Findings suggest that it is possible to achieve high rates of treatment completion for JIY, particularly within the context of family- and group-based interventions. However, these findings are limited by concerns about reporting of treatment completion and publication bias.
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Mental and behavioral health conditions are common among children and adolescents in the United States. The purpose of this state-of the-art review article is to describe inequities in mental and behavioral health care access and outcomes for children and adolescents, characterize mechanisms behind the inequities, and discuss strategies to decrease them. Understanding the mechanisms underlying these inequities is essential to inform strategies to mitigate these health disparities. Half of United States children with a treatable mental health disorder do not receive treatment from a mental health professional. Children and adolescents in racial, ethnic, sexual, sex, and other minority groups experience inequities in access to care and disparities in outcomes for mental and behavioral health conditions. Suicide rates are nearly twice as high in Black compared to White boys 5 to 11 years old and have been increasing disproportionately among adolescent Black girls 12 to 17 years old. Children identifying as a sexual minority have >3 times increased odds of attempting suicide compared to heterosexual peers. Adverse experiences of children living as part of a minority group, including racism and discrimination, have immediate and lasting effects on mental health. Poverty and an uneven geographic distribution of resources also contribute to inequities in access and disparities in outcomes for mental and behavioral health conditions. Strategies to address inequities in mental and behavioral health among United States children include investing in a diverse workforce of mental health professionals, improving access to school-based services, ensuring equitable access to telehealth, and conducting quality improvement with rigorous attention to equity.
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Justice-involved youth experience significantly higher rates of adverse childhood experiences (ACEs) compared to the general population, which lead to negative outcomes such as greater criminal involvement and mental health disorders. Such effects emphasize the need to examine the role of protective factors on the development of these negative outcomes. This study uses data from 519 youth referred to a probation department in Southeast Texas to examine the effects of ACEs and the direct and mitigating effects of protective factors on a youth’s criminal involvement and mental health symptoms. Results from hierarchical linear regression models emphasize the negative effects of ACEs on these outcomes, as well as the potential ceiling effect of protective factors based on ACE severity.
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School violence inside youth prisons proves challenging to explore. The diversity among incarcerated students, variation in the layout and management of youth prison schools, and the trauma caused by confinement factor into how school violence unfolds. This chapter makes four contributions to landscaping the study of school violence inside youth prison schools. First, contrary to popular stereotypes, students have offenses across a spectrum of non-violent to violent crimes. Second, classrooms in some youth prisons are the only social spaces and violence gets funneled into them. Third, school violence intervention programs used in youth prison schools must contend with the trauma-inducing aspects involved in living in a correctional setting. Fourth, public discourse misplaces attention on punitive responses outside of a complex understanding of the students, experiences inside youth prison schools, and possibilities beyond schooling behind bars. These contributions scaffold future directions in research on school violence in youth prison schools.
Article
Mental health concerns are highly prevalent in the juvenile justice system (JJS). Assessment practices vary significantly across probation departments, often relying on past medical history or unstructured clinical interviews. Numerous structured and semi-structured assessment tools exist, some of which have previously been used within JJS samples. The current research compared mental health diagnosis prevalence and distribution as assigned by the current practice in a probation department versus utilizing the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) in a sample of youth involved with the JJS. Results suggested the K-SADS identified a higher variety of mental health concerns with higher precision (e.g., all diagnoses were specified rather than unspecified). However, the standard assessment practice identified a higher prevalence of ADHD diagnoses, as well as “Other Conditions That May Be a Focus of Clinical Attention.” Limitations and future directions are discussed.
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School violence inside youth prisons proves challenging to explore. The diversity among incarcerated students, variation in the layout and management of youth prison schools, and the trauma caused by confinement factor into how school violence unfolds. This chapter makes four contributions to landscaping the study of school violence inside youth prison schools. First, contrary to popular stereotypes, students have offenses across a spectrum of non-violent to violent crimes. Second, classrooms in some youth prisons are the only social spaces and violence gets funneled into them. Third, school violence intervention programs used in youth prison schools must contend with the trauma-inducing aspects involved in living in a correctional setting. Fourth, public discourse misplaces attention on punitive responses outside of a complex understanding of the students, experiences inside youth prison schools, and possibilities beyond schooling behind bars. These contributions scaffold future directions in research on school violence in youth prison schools.
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Background: Both delinquency and out-of-home care (OOHC) are associated with a wide spectrum of psychiatric disorders. Reform schools (RS) are Finnish OOHC institutions for adolescents with severe conduct problems. Objective: We investigated the prevalence of psychiatric diagnoses among individuals with a history of RS placement. Participants and setting: The data consisted of individuals placed in a RS on the last day of the years 1991, 1996, 2001, 2006 or 2011 (N = 1074) and a matched comparison group (N = 5313). Methods: Information on lifetime psychiatric diagnoses, grouped into eight categories, was collected from the nationwide health care registry. The follow-up time ranged from 17 to 44 years. Results: Among RS population, 59.5 % had some psychiatric diagnosis, which was 12-fold compared to general population peers (hazard ratio HR = 12.4). The most prevalent categories were Conduct disorders and/or ADHD (30.7 %, HR = 41.5), Substance use disorders (29.3 %, HR = 16.8,), Other childhood disorders (8.6 %, HR = 11.9) and Personality disorders (10.9 %, HR = 11.6) followed by Mental retardation (6.4 %, HR = 8.4), Schizophrenia spectrum disorders (9.7 %, HR = 7.9), Affective disorders (17.9 %, HR = 7.3), and Disorders of psychological development (6.1 %, HR = 4.4). All differences were statistically significant (p < .001). Conclusions: RS background associates with an excess of psychiatric disorders, which adds to the burden of other known risk factors for adult age well-being. Effective screening and intervention for psychiatric problems should be available both during the RS placement and after-care.
Article
Introduction: Youth involved in the justice system have high rates of alcohol and other drug use, but limited treatment engagement. JJ-TRIALS tested implementation activities with community supervision (CS) and behavioral health (BH) agencies to improve screening, identification of substance use service need, referral, and treatment initiation and engagement, guided by the BH Services Cascade and EPIS frameworks. This paper summarizes intervention impacts on referrals to treatment among youth on CS. Methods: This multisite cluster-randomized trial involved 18 matched pairs of sites in 36 counties in seven states randomly assigned to core or enhanced conditions after implementing the core intervention at all sites for six months. Enhanced sites received external facilitation for local change team activities to reduce unmet treatment needs; Core sites were encouraged to form interagency workgroups. The dependent variable was percentage referred to treatment among youth in need (N = 14,012). Two-level Bayesian regression assessed factors predicting referral across all sites and time periods. Generalized linear mixed models using logit transformation tested two hypotheses: (H1) referrals will increase from baseline to the experimental period, (H2) referral increases will be larger in enhanced sites than in core sites. Results: Although the intervention significantly increased referral, condition did not significantly predict referral across all time periods. Youth who tested drug positive, had an alcohol/other drug-related or felony charge, were placed in secure detention or assigned more intensive supervision, or who were White were more likely to be referred. H1 (p < .05) and H2 (p < .0001) were both significant in the hypothesized direction. Interaction analyses comparing site pair differences showed that findings were not consistent across sites. Conclusions: The percentage of youth referred to treatment increased compared with baseline overall, and enhanced sites showed larger increases in referrals over time. However, variations in effects suggest that site-level differences were important. Researchers should carry out mixed methods studies to further understand reasons for the inconsistent findings within randomized site pairs, and how to further improve treatment referrals across CS and BH systems. Findings also highlight that even when CS agencies work collaboratively with BH providers to improve referrals, most justice-involved youth who need SU services are not referred.
Article
Childhood sexual assault (CSA) victimization and depression are global public health concerns that disproportionately affect youths involved in the juvenile justice system. Little research has examined the influence of CSA on the stability of depressive symptoms among repeat juvenile offenders. The present study tested a gendered model of the association between lifetime CSA victimization and depression for three time points: baseline juvenile assessment entry; second reentry; and third reentry. Further, covariate analyses were conducted to explore the impact of socio-demographics on CSA victimization and depression. Results indicate that CSA victimization was associated directly with baseline depression and indirectly with depression at second reentry for both male and female justice-involved youths. For white, male youth, there were significantly higher rates of depression over time, than other males. However, age, African American or Hispanic race/ethnicity, living situation, and urbanity were not significantly associated with CSA victimization at baseline or depression over time. These findings underscore the need for juvenile justice services that address exposure to childhood trauma and mental illness more effectively.
Chapter
Although many youths violate norms and break laws, substantially fewer engage in more serious transgressions that lead to processing and sanction by juvenile courts. In this chapter, we review the psychopathology (including substance use disorders) of youth who encounter the juvenile justice system and spend time in residential placement. In addition to these major topics, we consider several issues including the role of assessment of juveniles, identification of risk and protective factors, and treatment planning and evaluation. Key concepts such as capacity for prevention and their challenges are discussed. We conclude by outlining several clinical research needs that may be of service to current and future practitioners.
Article
Background Adolescent misuse of prescription opioids is hazardous. This study aimed to generate data on prescription opioid misuse trajectories across adolescence and identify risk factors and mechanisms for more dangerous use trajectories. Methods Using a prospective longitudinal cohort repeated measures design, baseline (Fall 2013) and seven semiannual assessments were administered through Spring 2017 in 10 public high schools in Los Angeles, CA. Frequency of past 30-day prescription opioid misuse was captured. Trajectory groups were identified using growth mixture modeling and multinomial logistic regression identified associations between baseline risk factors with membership in each trajectory group. Results Overall, 3395 students were evaluated (53.4% female, Mean [SD] age at baseline=14.58[0.40]; range=12.83-16.29). Four discrete misuse trajectories were identified among 1062 students: (1) Minimal/Experimental (infrequent time-limited use; range of estimated mean number of days using prescription opioid across waves=0.0-0.6 days]; N=705[20.8%]); (2) Low Deescalating (range=2.0-0.7 days; N=189[5.6%]); (3) Moderate Escalating (range=0.7-3.6 days; N=108[3.2%]); and (4) Frequent Persistent (range=4.7-9.4 days; N=60[1.8%]).Students reporting tobacco, cannabis, alcohol use, or impulsivity in 9th grade were more likely to demonstrate membership in the Moderate Escalating trajectory class when compared to 2333 (68.7%) students reporting sustained abstinence. Female sex, peer opioid misuse, alcohol use, other substance use, impulsivity, or delinquent behavior reported in 9th grade was associated with membership in the Frequent Persistent trajectory class. Conclusions Prescription opioid misuse in adolescence appears to follow 4 discrete trajectories, including the potentially problematic Moderate Escalating and Frequent Persistent trajectories. Female sex, peer influences, substance use, and intrapersonal risk factors were associated with membership in these classes.
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Background: Emerging evidence suggests that distant placements and multiple moves may be detrimental to young people in care settings. Less is known about the characteristics of young people in secure care most affected by these processes. Aims: This study examined distance from home and number of previous placements in English young people detained in secure care and their relationships with organisational and individual characteristics. Methods: Data were derived from the (2016) cross-sectional National Adolescent Study census of English young people in secure care, which included 1322 young people across secure mental health, welfare and Youth Justice establishments. Associations were described with odds ratios/95% confidence intervals (OR/CI). Results: Overall, 285 young people (26.4%) were in secure placements over 100 miles from their family/local authority while 54 (5.6%) had 10 or more previous placements. These rates were higher in secure welfare than other settings (73.8%; OR (CI) = 9.62 (5.72, 16.18), 12.7%; OR (CI) = 2.76 (1.29, 5.91) respectively), and there was significant overlap between long-distance placement and multiple placements (n = 22; OR (CI) = 2.26 (1.27, 4.04)). Younger age and presence of neurodevelopmental disorder were also associated with long-distance placements while psychiatric diagnosis, previous secure placement, and previous service contact were linked to multiple placements. Conclusions: Distant and/or multiple placements in young people in secure care appear common, particularly for those who are placed in secure welfare and who are younger and/or present with a psychiatric disorder. Multi-agency evaluations that capture the longitudinal experience of these vulnerable young people are needed to understand how undesirable patterns of placement in secure care occur and prevent future instances.
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For the perpetrator who directs the sexual act to the individual; different definitions can be made in terms of the modus operandi, the personality characteristics, the mental disorders, the repetition of the crime and the characteristics of the victim. This study aims to determine the risk factors and personality traits of adolescents who are perpetrators of sexual crimes and who are thought to be driven to crime, to examine how crime is committed or how crime history classifications are created, and to contribute to crime and behavioral sciences, penological interventions and rehabilitation initiatives by creating a different perspective. According to the results of the cases, perpetrators of sexual assault are mostly characterized as a heterogeneous group. Therefore, it is thought that reducing the perpetrators into homogeneous groups regarding their specific characteristics will facilitate the judicial process in order for the justice mechanism to function correctly.
Article
Background The juvenile justice system in the USA adjudicates over seven hundred thousand youth in the USA annually with significant behavioral offenses. This study aimed to test the effect of juvenile justice involvement on adult criminal outcomes. Methods Analyses were based on a prospective, population-based study of 1420 children followed up to eight times during childhood (ages 9–16; 6674 observations) about juvenile justice involvement in the late 1990 and early 2000s. Participants were followed up years later to assess adult criminality, using self-report and official records. A propensity score (i.e. inverse probability) weighting approach was used that approximated an experimental design by balancing potentially confounding characteristics between children with v. without juvenile justice involvement. Results Between-groups differences on variables that elicit a juvenile justice referral (e.g. violence, property offenses, status offenses, and substance misuse) were attenuated after applying propensity-based inverse probability weights. Participants with a history of juvenile justice involvement were more likely to have later official and violent felony charges, and to self-report police contact and spending time in jail (ORs from 2.5 to 3.3). Residential juvenile justice involvement was associated with the highest risk of both, later official criminal records and self-reported criminality (ORs from 5.1 to 14.5). Sensitivity analyses suggest that our findings are likely robust to potential unobserved confounders. Conclusions Juvenile justice involvement was associated with increased risk of adult criminality, with residential services associated with highest risk. Juvenile justice involvement may catalyze rather than deter from adult offending.
Article
In childhood and adolescence, overt antisocial and aggressive manifestations are typically diagnosed as conduct disorder (CD). Given that the emerging research has pointed to the influence of 5-HT2A receptors in the ontogeny of aggression, we aimed to analyze the association of its genetic polymorphisms with CD. The study included 228 male adolescent subjects (120 with and 108 without CD). CD was diagnosed according to Structured Clinical Interview for DSM-IV criteria, while evaluations of aggressive/dissociative behaviors were performed using psychometric questionnaires including the PCL-YV, OAS-M, KADS, and CBCL. Platelet 5-HT concentration was determined by spectrophotofluorometry. Genotyping of 5-HT2A receptor polymorphisms rs2070040, rs9534511, rs4142900, rs9534512 was performed using TaqMan SNP Genotyping Assays. Subjective irritability, physical aggression toward others, and antisocial behavior were strongly associated with the G allele of rs2070040 and rs4142900, and the C allele of rs9534511 and rs9534512. A significantly increased platelet 5-HT concentration in CD subjects, compared to controls, was lost after the correction according to the smoking status. Our results indicate an association of the studied HTR2A polymorphisms and their haplotypes with irritability and impulsivity traits, which may contribute to the aggressive and antisocial behavior in male adolescents with CD.
Article
Purpose: This study aims to identify the patient characteristics that may influence family involvement in a family-centered care program during detention. Design/methodology/approach: Little is known about the needs of incarcerated adolescents and their families. This exploratory study used a cross-sectional design to collect data from incarcerated adolescents with conduct disorder followed in a French outpatient psychiatric department. Logistic regression models were used to identify the sociodemographic, clinical and family characteristics of these incarcerated adolescents that could predict family involvement in their care. Findings: Among 44 adolescents with conduct disorder, the probability of family involvement during the adolescent's detention was 9.6 times greater (95% CI 1.2-14.4, p = 0.03) for adolescents with no than for those with cannabis substance use disorder, and family involvement decreased with the age of the adolescent (OR = 0.22, 95% CI 0.1-0.9, p = 0.04). Research limitations/implications: Increased knowledge of the characteristics of these adolescents and their families is needed to develop programs that will increase family interventions by specialty treatment services during detention. Originality/value: No study has yet been published on French incarcerated adolescents with conduct disorder. As conduct disorder is one of the most important mental health disorders among delinquent adolescents, this study provides knowledge about these adolescents and the need to involve their parents in their care to prevent the further escalation of problem behaviors.
Article
Objective This study aims to evaluate a group-based intervention for alcohol and other drug (AOD) use offered to incarcerated youth hospitalised with mental illness. Methods A six-session group-based intervention for AOD use was offered to young offenders with mental illness, hospitalised in the Adolescent Unit of the Forensic Hospital, Sydney, between June 2015 and May 2017. Pre- and post-intervention measures were collected using the Brief Psychiatric Rating Scale (BPRS), Treatment Entry Questionnaire, Drug-Related Locus of Control (DRLOC) and Drug-Taking Confidence Questionnaire, short version. Results Pre- and post-intervention measures were compared utilising paired t-tests. Following the intervention, there was a significant reduction in the severity of psychiatric symptoms rated using the BPRS and a significant difference in DRLOC measures, reflecting increased internal locus of control. Conclusions Improved internal drivers for reducing AOD use and improvement in symptoms of mental illness suggest similar interventions may be beneficial and may not impact recovery even during episodes of acute illness.
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Youth can become involved in the juvenile justice system through an arrest for a law or criminal violation or referral to the juvenile court for a status offense (crimes based on the youth's age such as truancy or curfew violations). Once involved in the juvenile justice system, there are several individuals and agencies that have decision-making power over youth's trajectory through the system (e.g., juvenile court judges, attorneys, probation officers). Justice-involved youth tend to have histories of trauma exposure and child welfare involvement. Once involved in the justice system, youth are often involved in multiple service systems such as mental health and education and experience a range of collateral consequences due to their involvement these system. As a result, there are several evidence-based programs that should be used to support justice-involved youth.
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Prison victimization constitutes a serious problem for organizations and individuals. It disrupts order in an institutional environment, and the experience of victimization can have a long-lasting psychological effect on incarcerated population, particularly juveniles. Relevant research suggests that the deprivation model and the importation model can help explain the occurrence of prison victimization. Using longitudinal data collected from a youth custodial facility in China, the current study examines factors that are believed to be predictors of prison victimization. Negative binomial regression, a commonly used tool for the analysis of prison victimization research using count data, is employed in the current study. The findings suggest that prior victimization experiences, reported record of violent delinquency, prison visitation, and demographics have significant impacts on in-prison victimization. The public policy implications of the findings are discussed at the end of the study.
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The revised edition of the Handbook offers the only guide on how to conduct, report and maintain a Cochrane Review. The second edition of The Cochrane Handbook for Systematic Reviews of Interventions contains essential guidance for preparing and maintaining Cochrane Reviews of the effects of health interventions. Designed to be an accessible resource, the Handbook will also be of interest to anyone undertaking systematic reviews of interventions outside Cochrane, and many of the principles and methods presented are appropriate for systematic reviews addressing research questions other than effects of interventions. This fully updated edition contains extensive new material on systematic review methods addressing a wide-range of topics including network meta-analysis, equity, complex interventions, narrative synthesis, and automation. Also new to this edition, integrated throughout the Handbook, is the set of standards Cochrane expects its reviews to meet. Written for review authors, editors, trainers and others with an interest in Cochrane Reviews, the second edition of The Cochrane Handbook for Systematic Reviews of Interventions continues to offer an invaluable resource for understanding the role of systematic reviews, critically appraising health research studies and conducting reviews.
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Objectives: To assess the sociodemographic, psychiatric and criminal profile of adolescent offenders complying with temporary custody for homicide/homicide attempt and to compare it to that of the population of adolescents in custody for other crimes. Methods: This cross-sectional study was based on the review of the medical records of 74 juvenile offenders in temporary custody at socioeducational agency Fundação de Atendimento Sócio-Educativo do Rio Grande do Sul. For the analysis, variables that presented p < 0.2 were included in multivariate adjustment through logistic regression. Results: The sample comprised males only, mostly with white skin color (55.6 vs. 57.9% for homicidal and non-homicidal, respectively) and with a high prevalence of school failure (77.8 vs. 91.2%). There was a high prevalence of family history of delinquency (88 vs. 81%). Only years of study and belonging or not to a criminal organization remained statistically significant in the multivariate model. Conclusion: The results show that having fewer years of study and denying belonging to a criminal organization are predictive factors of homicidal behavior in adolescent offenders (both with statistical relevance). The other variables were not statistically significant for this outcome. The present study may serve as a basis for further research, which may improve our understanding of risk factors for juvenile homicide.
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Aims: The aims were to (1) estimate the prevalence of alcohol and drug use disorders in prisoners on reception to prison, and (2) estimate and test sources of between study heterogeneity METHODS: Studies reporting the 12 month prevalence of alcohol and drug use disorders in prisoners on reception to prison from 1 January 1966 to 11 August 2015 were identified from 7 bibliographic indexes. Primary studies involving clinical interviews or validated instruments leading to DSM or ICD diagnoses were included; self-report surveys and investigations that assessed individuals more than 3 months after arrival to prison were not. Random-effects meta-analysis, and subgroup and meta-regression analyses were conducted. PRISMA guidelines were followed. Results: In total, 24 studies with a total of 18,388 prisoners across 10 countries were identified. The random-effects pooled prevalence estimate of alcohol use disorder was 24% (95% CI 21-27) with very high heterogeneity (I(2) = 94%). These ranged from 16 to 51% in male and 10 to 30% in female prisoners. For drug use disorders, there was evidence of heterogeneity by sex, and the pooled prevalence estimate in male prisoners was 30% (95% CI 22-38; I(2) = 98%; 13 studies; range 10-61%) and, in female prisoners, it was 51% (95% CI 43-58; I(2) = 95%; 10 studies; range 30-69%). On meta-regression, sources of heterogeneity included higher prevalence of drug use disorders in women, increasing rates of drug use disorders in recent decades, and participation rate. Conclusions: Substance use disorders are highly prevalent in prisoners. Around a quarter of newly incarcerated prisoners of both sexes had an alcohol use disorder, and the prevalence of a drug use disorder was at least as high in men, and higher in women.
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Background High rates of psychiatric disorders and comorbidities have been reported in juvenile detainees, and both phenomena are thought to contribute to repeat offending. However, research on this topic has been limited in Asian countries, like South Korea. The purpose of this study was to examine the prevalence of psychiatric disorders, comorbidity patterns, and the relationship between psychiatric disorders and repeat offending among a cross-section of youths detained in a male juvenile detention center in South Korea. Methods One hundred seventy-three juvenile detainees were recruited. The distribution of psychiatric disorders within the sample was estimated by applying criteria from the Diagnostic and Statistical Manual of Mental Disorders IV. Logistic regression was used to assess significant comorbidity patterns and relationships between psychiatric disorders and repeat offending. ResultsIn all, 90.8% of the detainees had at least one psychiatric diagnosis, and 75.1% had psychiatric comorbidities. The most common psychiatric disorder was alcohol use disorder, followed by conduct disorder and attention-deficit hyperactivity disorder. Among the comorbidities present, alcohol use disorder with disruptive behavior disorder was the most common combination. The presence of two psychiatric disorders was associated with a higher rate of recidivism, and alcohol use disorder was also associated with repeat offending when combined with disruptive behavior disorders, but not with anxiety disorders, major depression, or psychotic disorders. Conclusions Juvenile detainees evidence high rates of psychiatric disorders and comorbidities. Assessment of and intervention in psychiatric disorders, especially alcohol use disorder and comorbid alcohol use disorder with disruptive behavior disorders, may help prevent further offenses.
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Background: More than 30 million people are released from prison worldwide every year, who include a group at high risk of perpetrating interpersonal violence. Because there is considerable inconsistency and inefficiency in identifying those who would benefit from interventions to reduce this risk, we developed and validated a clinical prediction rule to determine the risk of violent offending in released prisoners. Methods: We did a cohort study of a population of released prisoners in Sweden. Through linkage of population-based registers, we developed predictive models for violent reoffending for the cohort. First, we developed a derivation model to determine the strength of prespecified, routinely obtained criminal history, sociodemographic, and clinical risk factors using multivariable Cox proportional hazard regression, and then tested them in an external validation. We measured discrimination and calibration for prediction of our primary outcome of violent reoffending at 1 and 2 years using cutoffs of 10% for 1-year risk and 20% for 2-year risk. Findings: We identified a cohort of 47 326 prisoners released in Sweden between 2001 and 2009, with 11 263 incidents of violent reoffending during this period. We developed a 14-item derivation model to predict violent reoffending and tested it in an external validation (assigning 37 100 individuals to the derivation sample and 10 226 to the validation sample). The model showed good measures of discrimination (Harrell's c-index 0·74) and calibration. For risk of violent reoffending at 1 year, sensitivity was 76% (95% CI 73-79) and specificity was 61% (95% CI 60-62). Positive and negative predictive values were 21% (95% CI 19-22) and 95% (95% CI 94-96), respectively. At 2 years, sensitivity was 67% (95% CI 64-69) and specificity was 70% (95% CI 69-72). Positive and negative predictive values were 37% (95% CI 35-39) and 89% (95% CI 88-90), respectively. Of individuals with a predicted risk of violent reoffending of 50% or more, 88% had drug and alcohol use disorders. We used the model to generate a simple, web-based, risk calculator (OxRec) that is free to use. Interpretation: We have developed a prediction model in a Swedish prison population that can assist with decision making on release by identifying those who are at low risk of future violent offending, and those at high risk of violent reoffending who might benefit from drug and alcohol treatment. Further assessments in other populations and countries are needed. Funding: Wellcome Trust, the Swedish Research Council, and the Swedish Research Council for Health, Working Life and Welfare.
Research
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The 2009 YPICHS gained a picture of the health status of young people in juvenile detention across NSW. This also included social determinants, offending behaviour, mental health, intellectual ability, traumatic experiences, alcohol/drug use, suicidality and education.
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Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
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We investigated the mental health of 232 consecutive receptions of juvenile boys aged 15–17 years in youth detention centers of two Chinese provinces and compared with juveniles in community settings. Interviews were conducted by psychiatrists using the Schedule for Affective Disorders and Schizophrenia for School-Age Children to diagnose DSM-IV psychiatric disorders. Of the 232 boys in detention, 188 (81.0%) met criteria for any psychiatric disorder, with 186 (80.2%) having a disruptive behavior disorder and 52 (22.4%) having a substance use disorder (SUD). High levels of comorbidity were observed with 38.8% being diagnosed with at least two disorders. The high absolute and relative risks of psychiatric disorders and SUDs suggest that the identification and treatment of such disorders in juvenile detention is a priority for service development.
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to determine the incidence and associations of attention deficit-hyperactivity disorder (ADHD), conduct disorder (CD), and substance abuse disorder (SAD) in adolescents in conflict with the law in a Brazilian cohort. the Brazilian version of the Schedule for Affective Disorders and Schizophrenia for School Aged-Children (K-SADS-PL) was administered to 69 adolescent boys who were incarcerated for 45 days in the city of Curitiba, Brazil. mean age was 15.5 years (range, 12-16.9 years) and most adolescents originated from disadvantaged social classes (87%). They resided in neighborhoods on the outskirts of the city or towns in the greater metropolitan area. Truancy and low educational achievement were common, with 73.9% not currently attending school and 43.4% not having finished the 5th grade. The great majority lived in single-parent families and many had relatives who themselves had problems with the law. Psychiatric disorders were apparent in 81.1% of the subjects, with the most common disorders being CD (59.4%), SAD (53.6%), and ADHD (43.5%). Both ADHD (p <0.001) and CD (p <0.01) had significant associations with substance abuse. in male adolescents in conflict with the law, ADHD, CD, and SAD were all found to be associated with delinquency.
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The objective of the present study was to analyse patterns of emotional, physical and sexual maltreatment in detained male juvenile offenders using latent class analysis (LCA). The association of maltreatment related LCA profiles with psychopathology and criminal behaviors was also studied. LCA based on the items of the Child Trauma Questionnaire (CTQ) assessing childhood emotional, physical, and sexual abuse was performed in a sample of 260 male adolescent offenders (mean age = 16.5 years, SD = 1.29 years). Chi square tests and general linear models were performed to assess the associations of CTQ profiles with categorical interview-based psychiatric disorders, dimensional Youth Self-Report problem scales, and officially registered offenses. LCA suggested a three class solution: (1) a no/mild trauma (NM; 76 %) (2) emotional and physical trauma (EP; 18 %) and (3) emotional, physical, and sexual trauma (EPS; 8 %). The classes EP and EPS were related to a variety of psychiatric disorders and self-reported mental health problems. Furthermore, EPS showed higher presence of a subsequent re-incarceration compared to NM. A majority of sexually abused juveniles also experienced emotional and physical abuse reflecting gravely disturbed family systems. Multiple abuse in childhood was associated with a broad variety of disorders including externalizing disorders and repeated criminal offending. Such findings indicate that trauma assessment is also relevant in externalizing youth. A comprehensive treatment approach for detained boys with multiple abuse experiences is required targeting both mental health needs and the reduction of criminal behaviors.
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To present the 12-month prevalence of DSM-IV major depressive disorder (MDD) and severe MDD, examine sociodemographic correlates and comorbidity, and describe impairment and service utilization.Method Data are from the National Comorbidity Survey-Adolescent Supplement (NCS-A), a nationally representative survey of 10,123 adolescents aged 13 to 18 years that assesses DSM-IV disorders using the Composite International Diagnostic Interview (CIDI) Version 3.0. One parent or surrogate of each participating adolescent was also asked to complete a self-administered questionnaire.ResultsLifetime and 12-month prevalence of MDD were 11.0% and 7.5%, respectively. The corresponding rates of severe MDD were 3.0% and 2.3%. The prevalence of MDD increased significantly across adolescence, with markedly greater increases among females than males. Most cases of MDD were associated with psychiatric comorbidity and severe role impairment, and a substantial minority reported suicidality. The prevalence of severe MDD was about a quarter of that of all MDD cases; estimates of impairment and clinical correlates were of 2- to 5-fold greater magnitude for severe versus mild/moderate depression, with markedly higher rates for suicidal thoughts and behaviors. Treatment in any form was received by the majority of adolescents with 12-month DSM-IV MDD (60.4%), but only a minority received treatment that was disorder-specific or from the mental health sector.Conclusion Findings underscore the important public health significance of depression among US adolescents and the urgent need to improve screening and treatment access in this population.
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Background Studies report the variable prevalence of attention deficit hyperactivity disorder (ADHD) in incarcerated populations. The aim of this meta-analysis was to determine the prevalence of ADHD in these populations. Method Primary research studies reporting the prevalence (lifetime/current) of ADHD in incarcerated populations were identified. The meta-analysis used a mixed log-binomial model, including fixed effects for each covariate and a random study effect, to estimate the significance of various risk factors. Results Forty-two studies were included in the analysis. ADHD prevalence was higher with screening diagnoses versus diagnostic interview (and with retrospective youth diagnoses versus current diagnoses). Using diagnostic interview data, the estimated prevalence was 25.5% and there were no significant differences for gender and age. Significant country differences were noted. Conclusions Compared with published general population prevalence, there is a fivefold increase in prevalence of ADHD in youth prison populations (30.1%) and a 10-fold increase in adult prison populations (26.2%).
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Previous studies have identified significant variability in attention-deficit / hyperactivity disorder (ADHD) prevalence estimates worldwide, largely explained by methodological procedures. However, increasing rates of ADHD diagnosis and treatment throughout the past few decades have fuelled concerns about whether the true prevalence of the disorder has increased over time. We updated the two most comprehensive systematic reviews on ADHD prevalence available in the literature. Meta-regression analyses were conducted to test the effect of year of study in the context of both methodological variables that determined variability in ADHD prevalence (diagnostic criteria, impairment criterion and source of information), and the geographical location of studies. We identified 154 original studies and included 135 in the multivariate analysis. Methodological procedures investigated were significantly associated with heterogeneity of studies. Geographical location and year of study were not associated with variability in ADHD prevalence estimates. Confirming previous findings, variability in ADHD prevalence estimates is mostly explained by methodological characteristics of the studies. In the past three decades, there has been no evidence to suggest an increase in the number of children in the community who meet criteria for ADHD when standardized diagnostic procedures are followed.
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Objective To assess the health and nutritional status of delinquent female adolescents on admission to a juvenile correctional facility. Methods :We performed a cross-sectional study over a 6-year period (1995-2000). Health status was assessed through medical history and physical examination according to standard protocols and individualized complementary laboratory examinations. Nutritional status was assessed using the anthropometric method. Height, weight, head and upper arm circumferences, body-mass index and nutritional index were determined and compared with normal national standards of reference (Z-score). Student’s single-sample t-test was used to assess statistically significant differences. Results Thirty-five delinquent female adolescents were admitted during the study period. Mean age was 15 years (0.72 SDU) (range: 14-17 years). The most frequently observed health problems were smoking (n 5 32), drug/alcohol abuse (n 5 22), high-risk sexual behavior (n 5 14), psychopathologic disorders (n 5 12), odontologic diseases (n 5 11), infectious diseases associated with intravenous drug use and/or high-risk sexual behavior (n 5 10) [specific vaginitis (n 5 3), bacterial vaginitis (n 5 2), AIDS (n 5 2), hepatitis C (n 5 2), hepatitis B (n 5 1)] and incomplete immunization status (n 5 6). Less prevalent health problems were iron deficiency anemia (n 5 3), positive pregnancy test (n 5 2), and dermatological (n 5 2), ophthalmological (n 5 2) and neurosensorial (n 5 1) disorders. No respiratory, locomotor, otorhinolaryngological, cardiovascular or gastrointestinal disorders were observed. Individual and group analysis of established anthropometric parameters and indices showed no growth or nutritional disorders. Conclusions In our environment, delinquent female adolescents arrive at correctional facilities with significant physical, psychological and behavioral problems. This population is especially in need of psychiatric, dental, gynecologic, infectious, and immunization services. The time in custody presents a unique opportunity to address the basic health concerns of this high-risk population and to provide general health education, including education on substance abuse and sex education.
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Youths formally referred to probation authorities in Texas (791 male, 200 female) self-administered a structured diagnostic interview at intake. Data on demographics, offense characteristics, and reoffending (within 12 months of baseline) were extracted from official justice records. Logistic regression analyses were used to evaluate the contribution of diagnosis to recidivism, adjusting for demographic and offense characteristics. Baseline externalizing disorders were associated with increased recidivism risk for both genders, whereas youths’ recidivism risk was not influenced by anxiety disorder. Girls with comorbid substance use and affective disorder were nearly four times more likely to reoffend than girls with no disorder. In contrast, among males, this disorder profile was associated with only approximately half the level of recidivism risk. Results substantiate practice guidelines that recommend comprehensive mental health assessment in juvenile justice settings and identify youths with certain mental health needs who might be well served by diversion programs.
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Because of the pressure for timely, informed decisions in public health and clinical practice and the explosion of information in the scientific literature, research results must be synthesized. Meta-analyses are increasingly used to address this problem, and they often evaluate observational studies. A workshop was held in Atlanta, Ga, in April 1997, to examine the reporting of meta-analyses of observational studies and to make recommendations to aid authors, reviewers, editors, and readers. Twenty-seven participants were selected by a steering committee, based on expertise in clinical practice, trials, statistics, epidemiology, social sciences, and biomedical editing. Deliberations of the workshop were open to other interested scientists. Funding for this activity was provided by the Centers for Disease Control and Prevention. We conducted a systematic review of the published literature on the conduct and reporting of meta-analyses in observational studies using MEDLINE, Educational Research Information Center (ERIC), PsycLIT, and the Current Index to Statistics. We also examined reference lists of the 32 studies retrieved and contacted experts in the field. Participants were assigned to small-group discussions on the subjects of bias, searching and abstracting, heterogeneity, study categorization, and statistical methods. From the material presented at the workshop, the authors developed a checklist summarizing recommendations for reporting meta-analyses of observational studies. The checklist and supporting evidence were circulated to all conference attendees and additional experts. All suggestions for revisions were addressed. The proposed checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion. Use of the checklist should improve the usefulness of meta-analyses for authors, reviewers, editors, readers, and decision makers. An evaluation plan is suggested and research areas are explored.
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To investigate changes in mental health and other needs, as well as clinical and diagnostic 'caseness', in a sample of adolescents over a 6-month period following entry into a Young Offenders Institution in the UK. Prospective cohort study. One Young Offenders Institution between November 2006 and August 2009. 219 male adolescents aged 15-18 years (M=16.56; SD=0.6) were assessed at baseline (median=4; range 0-26 days following reception into custody) on the Salford Needs Assessment Schedule for Adolescents (SNASA) and Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Participants were then reassessed at 3-month and 6-month postbaseline to document any change in mental health. Of the initial baseline sample, 132 were still in the study at 3-month postbaseline and 63 were still available for assessment at 6 months. There were no differences between those who were not available for assessment at the three key stages in terms of demographic and criminological data. Over time there was a general improvement in mental health. While the proportion of participants with a mental health need (SNASA) did not change over time, symptom severity as measured by the SNASA did reduce significantly. When we assessed diagnostic 'caseness' using the K-SADS, three young people showed significant mental health deterioration. In line with previous studies, we found that symptoms in prison generally improved over time. Prison may provide an opportunity for young people previously leading chaotic lifestyles to settle into a stable routine and engage with services; however, it is unclear if these would be maintained either within the prison or on release into the community.
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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.
Article
People involved with criminal justice frequently are exposed to violence and traumatic experiences. This may lead to posttraumatic stress disorder (PTSD); however, no review, to our knowledge, has synthetized findings in this setting. We conducted a systematic review and meta-analysis to estimate prevalence rates of PTSD in prison populations. Original studies in which prevalence rates of PTSD in unselected samples of incarcerated people were reported were systematically searched between 1980 and June 2017. Data were pooled using random-effects meta-analysis, and sources of heterogeneity for prespecified characteristics were assessed by meta-regression. We identified 56 samples comprising 21,099 imprisoned men and women from 20 countries. Point prevalence of PTSD ranged from 0.1% to 27% for male, and from 12% to 38% for female prisoner populations. The random-effects pooled point prevalence was 6.2% (95% confidence interval: 3.9, 9.0) in male prisoners and 21.1% (95% confidence interval: 16.9, 25.6) in female prisoners. The heterogeneity between the included studies was very high. Higher prevalence was reported in samples of female prisoners, smaller studies (n ≤ 200), and for investigations based in high-income countries. Existing evidence shows high levels of PTSD among imprisoned people, especially women. Psychosocial interventions to prevent violence, especially against children and women, and to mitigate its consequences in marginalized communities must be improved. Trauma-informed approaches for correctional programs and scalable PTSD treatments in prisons require further consideration.
Article
To investigate the association between mental disorders and recidivism in juveniles, a three-level meta-analysis of 20 manuscripts (17 independent studies, N = 5737 juveniles) was conducted. The study focused on internalizing disorders, externalizing disorders, and comorbid disorders (combinations of an internalizing and externalizing disorder). Small to moderate mean effect sizes were found for externalizing disorders (d = 0.415, p < 0.001) and comorbid disorders (d = 0.366, p < 0.001), and no relation was found between internalizing disorders and recidivism (d = 0.016, p = 0.877). For comorbid disorders, no significant variation was found between studies and between effect sizes within studies. Therefore, moderator analyses were only conducted for studies on internalizing and externalizing disorders. These analyses revealed that type of recidivism (e.g., rearrest, reincarceration), type of delinquency (e.g., overt and covert delinquency), and gender influenced the direction and magnitude of the associations between recidivism and internalizing and externalizing disorders.
Article
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.
Article
This paper examines mental illness amongst adult, juvenile, male, female, jail, and prison inmates. It also explores the way in which mental health diagnoses impact offending and violent behavior. Additionally, literature pertaining to differences between the genders and age of offenders was reviewed. Overall, the literature suggests that psychiatric disorders are more common amongst criminal offenders than the population at large. Further, it appears many mentally ill offenders do not receive sufficient treatment during their incarcerations and there are barriers inherent to incarceration which prevents adequate treatment of mental illnesses.
Article
Unprecedented global forces are shaping the health and wellbeing of the largest generation of 10 to 24 year olds in human history. Population mobility, global communications, economic development, and the sustainability of ecosystems are setting the future course for this generation and, in turn, humankind. At the same time, we have come to new understandings of adolescence as a critical phase in life for achieving human potential. Adolescence is characterised by dynamic brain development in which the interaction with the social environment shapes the capabilities an individual takes forward into adult life.3 During adolescence, an individual acquires the physical, cognitive, emotional, social, and economic resources that are the foundation for later life health and wellbeing. These same resources define trajectories into the next generation. Investments in adolescent health and wellbeing bring benefits today, for decades to come, and for the next generation. Better childhood health and nutrition, extensions to education, delays in family formation, and new technologies offer the possibility of this being the healthiest generation of adolescents ever. But these are also the ages when new and different health problems related to the onset of sexual activity, emotional control, and behaviour typically emerge. Global trends include those promoting unhealthy lifestyles and commodities, the crisis of youth unemployment, less family stability, environmental degradation, armed conflict, and mass migration, all of which pose major threats to adolescent health and wellbeing. Adolescents and young adults have until recently been overlooked in global health and social policy, one reason why they have had fewer health gains with economic development than other age groups. The UN Secretary-General's Global Strategy for Women's, Children's and Adolescents' Health initiated, in September, 2015, presents an outstanding opportunity for investment in adolescent health and wellbeing. However, because of limits to resources and technical capacities at both the national and the global level, effective response has many challenges. The question of where to make the most effective investments is now pressing for the international development community. This Commission outlines the opportunities and challenges for investment at both country and global levels (panel 1).
Article
Background: Because most individuals with mental illness are not hospitalized and most violent individuals are not convicted of crimes, hospital-and prison-based research underestimates the rates of mental illness and violence found in the general population. This study examined the overlap of mental disorders and violence in a birth cohort. Method: A total of 961 individuals born in Dunedin, New Zealand, from April 1, 1972, through March 31, 1973, (i.e., 94% of the total city birth cohort) were studied. DSM-III-R interviews were used to identify pastyear prevalence of mental disorders, and self-report of criminal offense and search of official conviction records were employed to measure past-year violence. The variables of substance use before the violent offense, excessive threat perception, and adolescent conduct disorder were studied as possible explanations for the link between mental disorders and violence. Results: Individuals with DSM-III-R alcohol dependence were 1.9 times (95% confidence interval [CI] = 1.0 to 3.5), those with marijuana dependence were 3.8 times (95% CI = 2.2 to 6.8), and those with schizophrenia-spectrum disorder were 2.5 times (95% CI = 1.1 to 5.7) more likely to be violent than individuals without a psychiatric disorder. Although individuals with at least 1 of these disorders committed half of the violent crimes reported in this study (one tenth of the violence accounted uniquely for by patients with schizophrenia-spectrum disorder), they constituted only one fifth of the study cohort. Substance use before the violent event accounted for the violence in individuals with alcohol dependence. Adolescent history of conduct disorder best explained violence in individuals with marijuana dependence. Both excessive threat perception and adolescent history of conduct disorder accounted for violence in individuals with schizophrenia-spectrum disorder. Conclusions: Individuals with mental illness were responsible for a substantial percentage of the violent acts committed by persons within their age group. Because the explanations for violence varied between groups of individuals with different mental disorders, multiple treatment and intervention strategies may be necessary to prevent the occurrence of violent acts.
Article
Youths who are detained or incarcerated in correctional facilities represent a medically underserved population that is at high risk for a variety of medical and emotional disorders. These youths not only have a substantial number of preexisting health problems, they also develop acute problems that are associated with their arrest and with the environment of the correctional facility. Although the availability of medical services varies by the size of the institution, established standards are, in general, not being met.
Article
Young offender populations typically display high rates of substance use pathology and mental health concerns, however, little is known regarding how these factors relate to dynamic risk factors for reoffending (criminogenic needs) among young offenders. The present study investigated a Canadian sample of 186 youth charged with serious/violent offenses on measures of psychopathology, substance abuse, risk, and recidivism. Significant relationships were found between measures of substance abuse with most indices of the Youth Level of Service/Case Management Inventory (YLS/CMI), a validated risk assessment tool designed to assess criminogenic risk and need. Furthermore, measures of substance abuse predicted general, violent, and nonviolent recidivism for both youth and adult outcomes to varying degrees. Youth with disruptive behavior disorders, comorbid substance use concerns with another disorder (dual diagnosis), or with two or more disorders evidenced more serious criminogenic need profiles, whereas mood, anxiety, and cognitive disorders were unrelated to criminogenic risk. With the exception of conduct disorder and substance use pathology, mental health concerns tended not to be related to recidivism. The implications of these findings in terms of assessing risk and providing treatment services for young offenders is discussed in relation to the risk-need responsivity (RNR) model of effective correctional intervention.
Article
Background: In adolescent offenders, oppositional defiant disorder (ODD) and its dimensions/subtypes have been frequently ignored due to the stronger focus on criminal behaviours. The revised criteria of the DSM-5 now allow diagnosing ODD in older youths independent of conduct disorder (CD). This study aimed at analysing ODD dimensions/subtypes and their relation to suicidality, comorbid psychiatric disorders, and criminal behaviours after release from detention in a sample of detained male adolescents. Methods: Suicidality and psychiatric disorders (including ODD symptoms) were assessed in a consecutive sample of 158 male adolescents (Mage = 16.89 years) from the Zurich Juvenile Detention Centre. Based on previous research findings, an irritable ODD dimension and a defiant/vindictive ODD dimension based on ODD symptoms were defined. Latent Class Analysis (LCA) was used to identify distinct subtypes of adolescent offenders according to their ODD symptom profiles. Logistic regression and Cox regression were used to analyse the relations of ODD dimensions/ODD subtypes to comorbid psychopathology and criminal reoffenses from official data. Results: The ODD-irritable dimension, but not the ODD defiant/vindictive dimension predicted comorbid anxiety, suicidality and violent reoffending. LCA identified four subtypes, namely, a no-ODD subtype, a severe ODD subtype and two moderate ODD subtypes with either defiant or irritable symptoms. The irritable ODD subtype and the severe ODD subtype were related to suicidality and comorbid affective/anxiety disorders. The irritable ODD subtype was the strongest predictor of criminal (violent) reoffending even when controlling for CD. Conclusions: The present findings confirm the presence of ODD dimensions/subtypes in a highly disturbed adolescent offender sample. Irritable youths were at risk of suicide and persistent criminal behaviours. Due to the severe consequences of irritability, a standardized assessment approach and a specific treatment is needed in prison to prevent suicide among the detainees and further harm to the society. As defined in the DSM-5, the present findings confirm the validity of ODD and ODD dimensions/subtypes as a diagnostic category among older youths.
Article
We investigated the psychometric properties of an 18-item modification of the Psychopathy Checklist (PCL) in a sample of 75 male young offenders incarcerated in a maximum-security institution. The distribution and psychometric properties of PCL scores were similar to those found in samples of young adult inmates. PCL scores were significantly correlated with the number of conduct-disorder symptoms, previous violent offenses, violent behavior in the institution, and violent recidivism. These and related results from several other studies indicate that the PCL shows promise as a research instrument for the assessment of psychopathy in male young offenders.