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

Article (PDF Available)inJournal of the American Academy of Child and Adolescent Psychiatry 47(9):1010-9 · October 2008with156 Reads
DOI: 10.1097/CHI.ObO13e31817eecf3 · Source: PubMed
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.
Copyright @ 2008 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
Mental Disorders Among Adolescents in Juvenile
Detention and Correctional Facilities: A Systematic
Review and Metaregression Analysis of 25 Surveys
SEENA FAZEL, M.R.C.PSYCH., M.D., HELEN DOLL, M.SC., D.PHIL.,
AND NIKLAS LÅNGSTRO
¨
M, M.D., PH.D.
ABSTRACT
Objective: 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. Method: 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. Results: Twenty-five surveys involving 13,778 boys and 2,972 girls (mean age 15.6 years, range 10Y19
years) met inclusion criteria. Among boys, 3.3% (95% confidence interval [CI] 3.0%Y3.6%) were diagnosed with psychotic
illness, 10.6% (7.3%Y13.9%) with major depression, 11.7% (4.1%Y19.2%) with ADHD, and 52.8% (40.9%Y64.7%) with
conduct disorder. Among girls, 2.7% (2.0%Y3.4%) were diagnosed with psychotic illness, 29.2% (21.9%Y36.5%) with
major depression, 18.5% (9.3%Y27.7%) with ADHD, and 52.8% (32.4%Y73.2%) 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. Conclusions: 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. J. Am. Acad. Child Adolesc. Psychiatry,
2008;47(9):1010Y1019. Key Words: detention, criminal justice, psychosis, systematic review.
Adolescents younger than 19 years constitute 5% of
all those detained in custody in Western countries,
including about 100,000 individuals in the United
States.
1
They are usually detained in separate closed
facilities or prisons. High prevalence of both undiag-
nosed and untreated physical and mental health
problems have been reported,
2,3
with current mental
disorders estimated to affect 40% to 70% of the ado-
lescents who come into contact with the justice system.
4
Deliberate self-harm and repeat offending are com-
mon,
5,6
and some of these disorders, such as substance
misuse and conduct disorder, are risk factors for criminal
recidivism.
7
In the United States and the United
REVIEW
Accepted April 18, 2008.
Dr. Fazel is with the Department of Psychiatry and Dr. Doll is with the
Department of Public Health and Primary Care, University of Oxford; Dr.
Långstro
¨
m is with the Center for Violence Prevention, Karolinska Institutet.
This work was in part supported from a grant from the Swedish Research
Council-Medicine (N.L.). The authors are grateful to the following investigators
who kindly provided additional information from their studies: P. Chitsabesan, C.
Duclos, R. Feinstein, P. Kirkish, D. Shelton, N. Singleton, A. Robertson, V.
Ruchkin, E. Trupin, C. Vreugdenhil, D. Waite, and R. Zabel.
Article Plus (online-only) materials for this article appear on the Journal’s Web
site: www.jaacap.com.
Correspondence to Dr. Seena Fazel, Department of Psychiatry, University of
Oxford, Warneford Hospital, Oxford OX3 7JX, UK; e-mail: seena.fazel@
psych.ox.ac.uk.
0890-8567/08/4709-1010*2008 by the American Academy of Child and
Adolescent Psychiatry.
DOI: 10.1097/CHI.0b013e31817eecf3
1010 WWW.JAACAP.COM J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 47:9, SEPTEMBER 2008
Copyright @ 2008 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
Kingdom, it has been argued that there is insufficient
screening for mental disorders, that sentencing does not
account for mental health issues, and that custodial and
secure facilities lack qualified staff and appropriate
treatment.
8,9
Although there have been many surveys of mental
health problems among juveniles in the criminal justice
system, there are methodological limitations that make
interpretation difficult and comparisons across studies
problematic. For example, a number of reports have
solely used self-report questionnaires
10,11
or data from
medical records
12,13
or interviewed selected popula-
tions
14,15
or those in care and foster homes rather
than in detention.
16
Others have reported prevalence
information for any psychiatric disorder rather than for
specific disorders
17
or used other measures of mental
distress than psychiatric diagnoses.
18,19
Previous narrative reviews of the literature on juvenile
offenders provided prevalence ranges for various mental
disorders, but did not examine the gray literature (only
partly or not formally published reports) systematically
or attempted to account for the wide variations in
prevalence estimates. Prevalence ranges were reported in
an American Academy of Pediatrics report, providing
estimates of 1% to 6% for psychosis, 20% to 60% for
conduct disorder, and 32% to 77% for attention-deficit/
hyperactivity disorder (ADHD).
3
A more recent review,
based on nine identified studies, provided prevalence
estimates of any psychiatric disorder of between 19%
and 78%.
20
Therefore, we conducted a systematic
review and meta-analysis of all of the available surveys of
psychiatric morbidity among adolescents in juvenile
detention to clarify the prevalence of mental disorders.
METHOD
Studies of the prevalence of mental disorder in boys and girls ages
19 years and younger in juvenile detention and correctional facilities
published between January 1966 and May 2006 were sought by
computer-based searc hes (EMBA SE, PsycINFO, Medline, U.S.
National Criminal Justice Reference System Abstract Database),
scanning of related reference lists, hand-searching of relevant
journals, and correspondence with authors of such reports, as
described previously.
21
Search terms combined those related to
juveniles (juvenile*, adol*, young*, youth*, boy*, or girl*) and
custody (prison*, jail*, incarcerat*, custod*, imprison*, or detain*).
Eligible surveys involved diagnoses of psychotic disorder, major
depression, ADHD, or conduct disorder following clinical examina-
tion and/or a clinical interview using structured diagnostic
instruments. We excluded surveys that involved juveniles referred
or selected specifically for psychiatric assessment (i.e., selected or
enriched
22
samples), solely used self-report instruments or where
prevalence data were not separated for males and females,
23Y27
unless
where the proportion of boys was >90%.
28,29
Psychotic illness,
depression, ADHD, and conduct disorder were included due to their
treatability and conduct disorder also because of its prognostic
value.
30,31
We excluded substance misuse because its prevalence is
likely to be substa ntially affected by various reporting and
ascertainment biases, including the availability of drugs at a
particular time and context. Psychotic illness included ICD and
DSM diagnoses of schizophrenia, bipolar affective disorder,
schizoaffective disorder, delusional disorder, and organic psychotic
disorder, but excluded psychotic symptoms secondary to substance
misuse. Major depression included ICD and DSM diagnoses of
unipolar affective disorder (with symptoms present for at least 2
weeks). For all four studied disorders, psychotic illness, depression,
ADHD, and conduct disorder, prevalence was related to a current
diagnosis (varying from within the past month to within the past 6
months, depending on instrument and study) according to the
ICD or the DSM. This led to the exclusion of one study
32
for the
calculation of estimates for psychotic illness (because prevalence was
reported for the past year) and another small study in which the
diagnostic time frame was not clarified.
33
We opted for current
rather than lifetime diagnosis of ADHD because this is consistent
with the DSM-IV. In addition, a previous study found that the
criterion insisting on age at onset before 7 years led to under-
reporting of ADHD because, in the absence of a caretaker informant,
most participants could not remember when their symptoms
began.
33
Finally, there was insufficient detail in included studies to
reliably estimate rates of comorbidity.
For each eligible study, data were abstracted independently by the
first and third authors according to a fixed protocol (supplemented
by correspondence with authors of relevant studies) and separately by
sex for geographic location, year of interview, sampling method
(consecutive admissions, total population, random, stratified ran-
dom, or som e combin ation), par ticipation rate, number of
interviewed youths, diagnostic instrument(s) and criteria (ICD or
DSM), type of interviewer (psychiatrist versus other), proportion of
individuals diagnosed with each studied disorder, mean age and
age range, mean duration of incarceration at the interview, and
proportion with violent offenses. Any discrepancies in the ratings
led to further review of the article and discussions with the authors,
where possible, and, if not, between the raters until consensus
was reached.
Data Analysis
Estimates of prevalence of particular disorders from different
studies were combined using fixed- or random-effects meta-
analysis, as appropriate, with the data presented in forest plots.
Smaller studies (those including <100 individuals) were aggregated,
with analyses being performed on the aggregated and nonaggre-
gated data. Heterogeneity among studies was estimated using
Cochran Q and the I
2
statistic, the latter describing the percentage
of variation across studies that is due to heterogeneity rather than
chance.
34,35
I
2
, unlike Q, does not inherently depend on the
number of studies considered. Heterogeneity was indicated by a Q
statistic (reported with a W
2
value) with p < .10, whereas in terms
of I
2
, values of 25%, 50%, and 75% can be taken to indicate low,
moderate, and high levels of heterogeneity, respectively.
18
We
calculated fixed estimates of pooled prevalence when heterogeneity
was not significant and random-effects estimates of overall pre-
valence when heterogeneity was significant.
36
Random-effects esti-
mates, in which the between-study variance is much larger than the
MENTAL DISORDERS AMONG ADOLESCENTS IN DETENTION
WWW.JAACAP.COM 1011J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 47:9, SEPTEMBER 2008
Copyright @ 2008 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
within-study variance (as is the case with significant heterogeneity),
give relatively similar weight to studies of different size. In contrast,
fixed-effects estimates are weighted by study size. Metaregression
was used to estimate the extent to which one or more measured
covariates (sex [in overall analyses], size of study [as a continuous
variable], study origin [United States versus elsewhere], instrument
[Diagnostic Interview Schedule for Children (DISC) versus another
instrument], interviewer [psychiatrist versus nonpsychiatrist], sam-
pling scheme [stratified/nonstratified random versus consecutive/
complete], and mean subject age [older than 15 years versus 15 years
or younger]) could explain the observed heterogeneity in prevalence
estimates.
32,37
The presented regression coefficients (") indicate
the average difference in prevalence proportion for one category
compared to the other (e.g., DISC versus another instrument)
adjusted for the effect of all of the other variables in the model. The
influence of individual studies on the summary effect was explored
using an influence analysis, in which meta-analysis estimates are
computed omitting one study at a time.
38
All of the analyses
were undertaken with STATA statistical software package, version
10.0.
RESULTS
Twenty-five surveys meeting the inclusion criteria
were identified, involving 16,750 adolescents of whom
13,778 were boys and 2,972 girls (see Table A, which is
available online through the Article Plus feature on the
Journal’s Web site at www.jaacap.com).
28,29,32,33,39Y54
Their weighted mean age was 15.6 years (range 10Y19
years). Fifteen surveys were conducted in the United
States (N = 15,628 adolescents),
28,29,33,39Y44,48Y50,55Y57
four in the United Kingdom (N = 264)
32,46,52,58
and
one each in Australia (N = 100),
59
Russia (N = 370),
47
Holland (N = 204),
53
Denmark (N = 100),
45
Canada
(N = 49),
51
and Spain (N = 35).
54
Sampling strategies
included consecutive recruitment of participants (N =
12,577 juveniles),
28,39,43,45Y50,52,53,55Y57
stratified ran-
dom sampling (N = 2,824),
32,33,40,46
simple random
sampling (N = 870),
29,41,44
and a complete sample
(N = 430).
42,47
For one study with 49 participants,
51
the recruitment strategy was not reported. Nineteen
studies (N = 15,668 juveniles) reported response
rates,
28,29,32,33,39,41Y43,45Y50,52,55Y58
only three of which
(N = 176) were less than 75%.
29,46,56
The following
instruments were used: the DISC,
33,41,42,49,53,56,57
the
Diagnostic Interview for Children and Adolescents-
Revised,
28,51
Research Diagnostic Criteria for depres-
sion,
48
the Schedule for Affective Disorders for
School-Age Children, Present, Lifetime or Epidemio-
logic Version,
45Y47,59
the Adolescent Psychopathology
Scale and Juvenile Detention Interview,
44
the Practical
Adolescent Dual Diagnostic Interview,
55
the Salford
Needs Assessment Schedule for Adolescents,
58
and a
semistructured instrument.
40
All of the studies yielded
DSM diagnoses apart from two that provided ICD-10
diagnoses for 145 juvenile detainees (less than 1% of
the total number included in the review).
32,45
Where
described, all of the studies solely used the juveniles
as informants.
Figure 1 presents sex-specific prevalence estimates for
psychotic illness, major depression, ADHD, and conduct
disorder by study along with an overall estimate. Influence
analysis (plots not shown) indicated that larger studies had
the most influence on the results, although for the
random-effects estimates (calculated because of signifi-
cant study heterogeneity for all of the disorders except
psychotic illnesses), no study had statistically significant
influence on the overall estimate. For the fixed-effects
estimate of the prevalence of psychotic disorder, only one
large study
39
had a significant influence on the estimate
in boys (so that excluding this study led to an estimate
outside the 95% CI of the overall estimate).
Psychotic Illnesses
We identified 12 surveys with information on
psychotic illnesses
33,39Y46,54,58,59
including a total of
14,710 adolescents. Overall, 430 of 12,468 boys (fixed-
effects pooled prevalence 3.3%; 95% CI 3.0%Y3.6%
[Fig. 1]) had a current psychotic disorder. There was
some heterogeneity with respect to prevalence among
these studies (W
2
9
= 15.7, p = .07) with a low to
moderate I
2
of 42.7%. On metaregression, no tested
factor significantly explained this heterogeneity in
prevalence. In the girls, three smaller studies
44,54,58
were aggregated and 64 of 2,242 individuals (fixed-
effects pooled prevalence 2.7%; 95% CI 2.0%Y3.4%)
had a psychotic illness, with little heterogeneity among
studies (W
2
4
= 3.3, p = .51) and an I
2
of 0.0%. In the
nonaggregated data, one study
44
with zero prevalence
was excluded, and 64 of 2,163 girls (2.9%; 95% CI
2.2%Y3.6%) had a psychotic illness. Because of lack of
heterogeneity, metaregression on the estimates was not
performed; there was no significant difference in the
prevalence of psychotic ill ness between males and
females (" = .004, SE(") = .004; p = .30).
We looked separately at manic episodes among these
surveys. Four studies reported on rates of manic episodes
in boys,
28,32,33,41
and with the zero prevalence study
excluded,
32
there was an aggregated prevalence of 3.1%
(95% CI 0.4%Y5.7%) using a random-effects model
(W
2
2
= 9.9, p =.007, I
2
= 79.8%). Only one study
FAZEL ET AL.
1012 WWW.JAACAP.COM J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 47:9, SEPTEMBER 2008
Copyright @ 2008 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
MENTAL DISORDERS AMONG ADOLESCENTS IN DETENTION
WWW.JAACAP.COM 1013J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 47:9, SEPTEMBER 2008
Copyright @ 2008 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
Fig. 1 Prevalence of four major mental disorders among juveniles (boys and girls) in custody. Psychotic illnesses. Boys: W
2
9
= 15.7 p = .073; I
2
= 42.7%. Girls:
W
2
4
= 3.32, p = .51; I
2
= 0.0%. Major depression. Boys: W
2
9
= 91.5, p < .001; I
2
= 90.2. Girls: W
2
3
= 29.8, p < .001; I
2
= 85.1%. Attention-deficit/hyperactivity
disorder. Boys: W
2
7
= 589.7, p < .0001; I
2
= 98.8%. Girls: W
2
4
= 137.3, p < .001; I
2
= 97.1%. Conduct disorder. Boys: W
2
8
= 754.5, p < .0001; I
2
= 98.9%. Girls: W
2
3
= 265.0, p < .001; I
2
= 98.9%. The figure for psychosis assumes a fixed-effects model; the others are random effects. Error bars indicate 95% CIs around individual
study prevalences. The open diamond-shaped symbol at the bottom of each plot denotes the pooled (fixed or random effects) mean prevalence with 95%
confidence interval. The W
2
(Cochran Q) and the I
2
estimates are measures of heterogeneity; the latter expresses the percentage of variation across studies resulting
from heterogeneity rather than chance. CI = confidence interval.
FAZEL ET AL.
1014 WWW.JAACAP.COM J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 47:9, SEPTEMBER 2008
Copyright @ 2008 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
reported on bipolar disorder.
28
In the girls, one survey
presented prevalence estimates; 1.2% (95% CI
0.6%Y2.4%) for manic episodes with impairment.
33
Major Depression
Eighteen surveys reporting on major depression were
identified
28,33,41,42,45Y51,53Y59
including a total of 4,959
adolescents. Overall, 391 of 3,323 boys (random-effects
pooled prevalence 10.6%; 95% CI 7.3%Y13.9%) and
457 of 1,633 girls (29.2%, 21.9%Y36.5%) were
diagnosed with current major depression. There was
substantial heterogeneity in the reported prevalences
even after aggre gating seven small er st udies for
boys
32Y36,42,46
and10forgirls
26,28,32Y34,36,40Y42,44
(W
2
9
= 91.5, p <.001, I
2
= 90.2% in boys; W
2
3
= 29.8,
p < .001, I
2
= 89.9% in girls). In the nonaggregated
data, the random-effects pooled preval ences were
slightly higher for both boys, at 11.4% (95% CI
8.5%Y14.2%) and for girls at 29.7% (95% CI
22.1%Y37.3%). On m etaregressi on, adjus ting for
study size and mean age (both with a nonsignificant
association with prevalence), this heterogeneity was
explained by sex (girls having higher prevalences: " =.16,
SE["] = .04; p < .001), type of instrument (studies using
the DISC yielding lower prevalences: " = j.18, SE["]=
.04; p < .001), and type of interviewer (studies using
psychiatrist interviewers having lower prevalences: " =
j.14, SE["] = .05; p = .003), irrespective of whether an
instrument was used. Thus, on subgroup analysis for
all of the studies that used instruments (excluding two
reports
54,58
), lower prevalen ces of depression were
reported when the instruments were administered by
psychiatrists rather than other interviewers (" = j.15,
SE["] = .06; p = .018).
ADHD
We identified 13 surveys that reported on ADHD
among a total of 14,639 adolescents.
28,33,39,41,45,47,
49,51,53,54,57Y59
Overall, 2,549 of 12,057 boys (random-
effects pooled prevalence 11.7%; 95% CI 4.1%Y19.2%)
and 613 of 2,582 girls (18.5%; 95% CI 9.3%Y27.7%)
were diagnosed with current ADHD. There was
substantial heterogeneity in prevalences across studies
even after aggregating three smaller studies for
boys
33,35,36
and four for girls
33,36,40,44
(W
2
7
= 589.7,
p < .0001, I
2
= 98.8% in boys; W
2
4
= 137.3, p < 0.001,
I
2
= 97.1% in girls). In the nonaggregated data, the
random-effects pooled prevalences were slightly higher
for boys at 12.4% (95% CI 5.1%Y19.7%) but lower for
girls at 15.2% (95% CI 6.9%Y23.5%). On metaregres-
sion, the heterogeneity was explained principally by
size of study (larger studies tending to have higher
prevalences: >250 versus e 250 adolescents; " = .18,
SE["] = .02; p < .001). After adjusting for study size and
mean age (considered continuously, studies with older
participants having lower prevalences: " = j.07, SE["]=
.01; p < .001), location of study (studies from the United
States yielding lower prevalences: " = j.11, SE["] = .02;
p < .001), type of instrument (studies using the DISC
yielding lower prevalences: " = j.07, SE["] = .01; p <
.001), and type of sampling (investigations using
consecutive entrants or a complete sample having higher
prevalences: " = .07, SE["] = 0.01; p < .001) had
significant relations with prevalence. All of the above
relations, with the exception of type of sampling, tended
to be stronger the smaller the study.
Conduct Disorder
Fifteen surveys reported on conduct disorder
28,29,32,
33,39,41Y45,47,49,51Y55,59
including a total of 14,667 ju-
venile inmates. Of 12,552 boys, 7,818 (random-effects
pooled prevalence 52.8%; 95% CI 40.9%Y64.7%) and
1,007 of 2,115 girls (52.8%, 95% CI 32.4%Y73.2%)
were diagnosed with conduct disorder. Again, there
was substantial heterogeneity in prevalences among
these studies even after aggregating six smaller studies
for boys
14,33,35Y38
and four for girls
26,33,36,41
(W
2
8
=
754.5, p < .001, I
2
= 98.9% in the boys; W
2
3
= 265.0,
p < .001, I
2
= 98.9% in the girls). In the nonaggregated
data, the random-effects pooled prevalences were slightly
higher for boys at 53.9% (95% CI 43.5%Y64.4%) as
compared with girls (44.8%; 95% CI 27.1%Y62.5%).
On metaregression, this heterogeneity was explained only
by type of instrument (studies using the DISC having
lower prevalences: " = j.21, SE["]=.10;p =.030) and
mean age (studies with mean age older than 15 years
having higher prevalences: " =.26,SE["]=.10;p = .009).
DISCUSSION
This systematic review of 25 psychiatric surveys
including 16,750 incarcerated adolescents found that
approximately 3% of juveniles in detention had a
psychotic illness and that typically 11% of the boys and
29% of the girls had a major depressive disorder. The
prevalence of ADHD varied between one in 10 for boys
MENTAL DISORDERS AMONG ADOLESCENTS IN DETENTION
WWW.JAACAP.COM 1015J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 47:9, SEPTEMBER 2008
Copyright @ 2008 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
and one in five for girls. As would be expected, because
of considerable symptom overlap between conduct
disorder and antisocial behavior, conduct disorder was
the most common of the studied disorders, similarly
prevalent across sexes at slightly more than 50%.
Two main implications arise from these findings.
First, adolescent girls in detention are at particular risk
for major depression. The prevalence reported in this
study at 29% is considerably higher than that reported
in adult prisoners in which a previous systematic review
found that 12% of women were diagnosed with
depression.
21
A second implication is th at mental
disorders are substantially more common in adolescents
in detention than among age-equivalent individuals in
the general population. The largest risk increase is for
conduct disorder: in girls, the prevalence is 10 to 20
times higher than community estimates, and in boys, it
is five to 10 times higher.
31,60
For psychoses, the risk
increase is about 10 times
60,61
and for ADHD, it is two
to four times.
60,62
Finally, major depression is about
four to five times more common in girls and twice as
common in detained boys compared with the general
adolescent population.
63,64
These proportionate
excesses for juveniles in custody compared with the
general population suggest that depression, ADHD, and
psychotic illness are associated with criminality, the
impact of detention, and/or the development of
antisocial behavior, directly or indirectly (e.g., through
confounding by socioeconomic adversity, excessive
familial conflict, child maltreatment, comorbid conduct
or substance use disorder).
63,65Y67
The findings on depression are notable. A recent
meta-analysis suggested that sex differences are modest
for adolescent depression in the general population.
64
Therefore, the present findings imply that antisocial
girls are either more depressed than antisocial boys
before detainment or more vulnerable to experiences
related to the confinement itself. The relative impor-
tance of depressive d isorder, or some associated
confounder, for criminal behavior in female compared
to male adolescents warrants further investigation.
The metaregression suggested that surveys using the
DISC, a highly structured psychiatric interview admi-
nistered by laypersons, yielded lower prevalences than
other instruments for depression, ADHD, and conduct
disorder. Informants across studies were the juveniles
themselves. Interestingly, investigations of adolescents
with conduct disorder have previously found that the
DISC, when administered in this way (in contrast to
when parents are also informants), may underdiagnose
depression
68
and ADHD.
26,68
Because the DISC is
widely used, our findings suggest that studies comparing
it with other validated instruments and clinical interview
would be useful. Finally, the metaregression suggested
that surveys reporting prevalences of depression with
psychiatrists acting as interviewers led to lower preva-
lences than if nonpsychiatrists did the interviews, even
when an instrument was used, a result consistent with
prevalence studies of depression in adult prisoners.
21
One of the implications of these findings is whether
there are ways to improve the diagnostic validity of
surveys in juvenile detention. The use of informants and
clinically trained interviewers would likely improve
diagnostic validity, although studies comparing different
approaches are necessary to confirm this. Although there
was little heterogeneity in the studies that reported on
psychosis, Teplin and colleagues
33
proposed sensible
adaptations in the use of the DISC that could be made
for other diagnoses. In their study, all of the individuals
who screened positive for psychosis were counted as
cases if their symptoms had lasted for more than 1 week,
were drug or alcohol free during this period, and a
psychiatrist or clinical psychologist reviewed the cases.
33
This systematic review found significant heterogene-
ity in the prevalences of depression, ADHD, and
conduct disorder, and the overall pooled prevalences for
these disorders reported must be interpreted with
caution. We explored the heterogeneity using metare-
gression, which was limited to the characteristics
reported in the studies. Clearly, other factors may have
been important in explaining the differences between
the investigations, such the type of detention facility and
associated characteristics. The latter may include the
amount of purposeful or meaningful daytime activity,
overcrowding, assault rates, and service provision within
custody, some of which are associated with suicide
rates.
69
Unfortunately, such information about the
facilities was limited and inconsistently reported in
individual studies. Reporting the range of prevalences is
an alternative approach to deal with heterogeneity. We
were not able to report on rates of substance abuse
because most of the studies provided insufficient data.
Furthermore, prevalence of substance use disorders
will be complicated by local factors including the
availability of illegal drugs and alcohol in a particular
setting during a specific period and reporting biases.
FAZEL ET AL.
1016 WWW.JAACAP.COM J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 47:9, SEPTEMBER 2008
Copyright @ 2008 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
Information on the specificity and sen siti vity of
diagnostic screening tools was lacking in the included
reports. Although 89% of the juveniles included in
this review were from U.S. detention facilities, a
related limitation is that included surveys were from
different countries , with varying ar rest patter ns,
adjudication and detention policies, and background
prevalences of psychiatric disorders, all of which may
contribute to the observed heterogeneity in preva-
lences. However, this limitation did not contribute to
the heterogeneity for the prevalence estimates for
depression and conduct disorder. For ADHD they
did, but in an unexpected direction; studies done
outside the United States found higher prevalence
estimates of ADHD than U.S. studies.
One important clinical implication of our review is
the role of mental health care in juvenile justice. As
delinquent adolescents often come from deprived
backgrounds with little access to and use of health
care in the community, opportunities for intervention
in juvenile justice have the potential to make a
significant impact on public health terms.
70
The
structure of service provision in such settings will
depend on national and local factors, but there is
evidence of the role of academic medicine in
organizing services delivery
71
for adults in detention.
The American Academy of Child and Adolescent
Psychiatry has proposed practice guidelines, some of
which are underlined by the findings of this review.
Specifically, they recommend that all young people
should be screened for mental disorder and suicide risk
on entering justice facilities.
72
The Academy’s guide-
lines highlight the comprehensive screening for suicide
risk and substance abuse, whereas the findings of this
review suggest that this should be extended to mood
disorders, especially in girls. Although the Academy
recommends self-report methods for screening, our
findings and other research suggest avoiding relying
solely on self-report approaches.
73
After initial screen-
ing, the Academy recommends monitoring, with
particular attention to those in larger institutions
who may not be followed unless their behavioral
disturbance is severe. The importance of relat ed
mental health needs, including substance abuse,
74
literacy, and accommodation, should also be consid-
ered. Our findings highlight the recommendation that
all juvenile justice facilities should have a suicide
prevention program
72
because mental disorders are
risk factors for suicide
75
and suicide in young people
in detention is considerably higher than in the age-
matched general population. In a U.K. longitudinal
study (>26 years), it was 18 times higher.
76
Research implications of the review include the need
for longitudinal studies of juveniles in detention that
would be helpful to identify the relative contributions
and interactions of various risk factors for psychiatric
disorders in prisons. Investigations of screening for
mental disorders and suicide risk are a priority, and
tools with good positive predictive value and ease of
use should be further assessed and, if appropriate,
developed and implemented. Studies of repeat offend-
ing after juvenile detention could examine the
psychiatric determinants of recidivism and whether
individuals with mental disorders are more likely to
reoffend than other criminals. Research could also
assist in understanding the extent of deliberate self-
harm in juvenile justice,
77
its associations with mental
illness, and relation to suicide in detention and after
leaving detention.
78
Finally, randomized, controlled
treatment trials of psychiatric treatment, including its
effect on suicide risk, institutional behavior , and
criminal recidivism, are necessary in juvenile justice.
It is likely that due to the unusual environment and
the selected nature of the population, standard
treatments used in community settings will have to
be modified to increase their efficacy for those in
detention.
72
In conclusion, the present findings should have
implications for the provision of adequate psychiatric
services for boys and girls in detention. Early diagnosis
and treatment are likely to confer prolonged psychia-
tric,
79,80
violence and crime reduction,
7,65,66
and wider
public health benefits.
70
Disclosure: The authors report no conflicts of interest.
REFERENCES
1. Snyder H, Sickmund M. Juvenile Offenders and Victims: 2006 National
Report. Washington, DC: Office of Juvenile Justice and Delinquency
Prevention; 2006.
2. Council on Scientific Affairs, American Medical Association. Health
status of detained and incarcerated youths. JAMA. 1990;263:
987Y991.
3. American Academy of Pediatrics Committee on Adolescence. Health care
for children and adolescents in the juvenile correctional care system.
Pediatrics. 2001;107:799Y803.
MENTAL DISORDERS AMONG ADOLESCENTS IN DETENTION
WWW.JAACAP.COM 1017J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 47:9, SEPTEMBER 2008
Copyright @ 2008 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
4. Arroyo W, Buzogany W, Hansen G. American Academy of Child and
Adolescent Psychiatry (AACAP) Task Force on Juvenile Justice Reforms:
Recommendations for Juvenile Justice Reform. Washington, DC: AACAP;
2001.
5. Langan P, Schmitt E, Durose M. Recidivism of Sex Offenders Released
From Prison in 1994. Washington, DC: U.S. Department of Justice;
2003.
6. Home Office, Prison Statistics 2002: England and Wales. London: HMSO;
2003.
7. Cottle C, Lee R, Heilbrun K. The prediction of criminal recidivism in
juveniles: a meta-analysis. Criminal Justice Behav. 2001;28:367Y394.
8. Kessler C. Need for attention to mental health of young offenders.
Lancet. 2002;359:1956Y1957.
9. Bailey S. Editorial. J Adolesc. 2000;23:237Y241.
10. Grisso T, Steinberg L, Woolard J, et al. Juveniles’ competence to stand
trial: a compariso n of adolescents’ and adults’ capacities as trial
defendants. Law Hum Behav. 2003;27:333Y363.
11. Bickel R, Campbell A. Mental health of adolescents in custody: the use
of the Adolescent Psychopathology Scale in a Tasmanian context. Aust N
Z J Psychiatry. 2002;36:603Y609.
12. Rawal P, Romansky J, Jenuwine M, Lyons J. Racial differences in the
mental health needs and service utilization of youth in the juvenile justice
system. J Behav Health Serv Res. 2004;31:242Y254.
13. Kramp P, Israelson L, Mortensen K, Aarkrog T. Serious juvenile
offenders: demographic variables, diagnostic problems, and therapeutic
possibilities. Int J Law Psychiatry. 1987;10:63Y73.
14. Forth A, Hart S, Hare R. Assessment of psychopathy in male young
offenders. Psychol Assess . 1990;2:342Y344.
15. Kroll L, Rothwell J, Bradley D, Shah P, Bailey S, Harrington R. Mental
health needs of boys in secure care for serious or persistent offending: a
prospective, longitudinal study. Lancet. 2002;359:1975Y1979.
16.McCannJ,JamesA,WilsonS,DunnG.Prevalenceofpsychiatric
disorders in young people in the care system. BMJ. 1996;13:
1529Y1530.
17. Otto-Salaj L, Gore-Felton C, McGarvey E , Canterbury R. Psychiatric
functioning and substance use: factors associated with HIV risk
among incarcerated adolesce nts. Child Psychiatry H um Dev. 2002;33:
91Y106.
18. Cohen R, Parmalee D, Irwin L, et al. Characteristics of children and
adolescents in a psychiatric hospital and a corrections facility. J Am Acad
Child Adolesc Psychiatry. 1990;29:909Y913.
19. Steiner H, Cauffman E, Duxbury E. Personality traits in juvenile
delinquents: relation to criminal behavior and recidivism. J Am Acad
Child Adolesc Psychiatry. 1999;38:256Y262.
20. Golzari M, Hunt SJ, Anoshiravani A. The health status of youth in
juvenile detention facilities. J Adolesc Health. 2006;38:776Y782.
21. Fazel S, Danesh J. Serious mental disorder in 23 000 prisoners: a
systematic review of 62 surveys. Lancet. 2002;359:545Y550.
22. Neighbors B, Kempton T, Forehand R. Co-occurrence of substance
abuse with conduct, anxiety, and depression disorders in juvenile
delinquents. Addictive Behav. 1992;17:379Y386.
23. Marsteller F, Brogan D, Smith I, et al. The Prevalence of Substance
Use Disorders Among Juveniles Admitted to Regional Youth Detention
Centers Operated by the Georgia Depart ment of Children and Youth
Services. Atlanta: Georgia Department of Children and Youth
Services; 1997.
24. Eppright T, Kashani J, Robison B, Reid J. Comorbidity of conduct
disorder and personality disorders in an incarcerated juvenile population.
Am J Psychiatry. 1993;150:1233Y1236.
25. Davis D, Bean G, Schumacher J, Stringer T. Prevalence of emotional
disorders in a juvenile justice institutional population. Am J Forensic
Psychol. 1991;9:5Y17.
26. Ko S, Wasserman G, McReynolds L, Katz L. Contribution of parent
report to voice DISC-IV diagnosis among incarcerated youths. J Am Acad
Child Adolesc Psychiatry. 2004;43:868Y877.
27. Garland A , Hough R, McCabe K, Yeh M, Wood P, Aarons G.
Prevalence of psychiatric disorders i n youths across five sec-
tors of care. JAmAcadChildAdolescPsychiatry. 2001;40:
409Y418.
28. Pliszka S, Sherman J, Barrow M, Irick S. Affective disorder in
juvenile offenders: a preliminary study. Am J Psychiatry. 2000;157:
130Y132.
29. Atkins D, Pumariega A, Rogers K, et al. Mental health and incarcerated
youth. I: prevalence and nature of psychopathology. J Child Fam Studies.
1999;8:193Y204.
30. Kratzer L, Hodgins S. Adult outcomes of child conduct problems: a
cohort study. J Abnorm Psychol. 1997;25:65Y81.
31. Loeber R, Burke J, Lahey B, Winters A, Zera M. Oppositional defiant
and conduct disorder: a review of the past 10 years, part I. J Am Acad
Child Adolesc Psychiatry. 2000;39:1484Y1486.
32. Lader D, Singleton N, Meltzer H. Psychiatric Morbidity Among Youth
Offenders in England and Wales. London: Office for National Statistics;
2000.
33. Timmons-Mitchell J, Brown C, Schulz S, Webster S, Underwood L,
Semple W. Comparing the mental health needs of female and
male incarcerated juvenile delinquents. Behav Sci Law. 1997;15:
195Y202.
34. Teplin L, Abram K, McClelland G, Dulcan M, Mericle A. Psychiatric
disorders in youth in juvenile detention. Arch Gen Psychiatry. 2002;59:
1133Y1143.
35. Higgins J, Thompson S, Deeks J, Altman D. Measuring inconsistency in
meta-analyses. BMJ. 2003;327:557Y560.
36. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin
Trials. 1986;7:177Y188.
37. Thompson S, Higgins J. How should meta-regression analyses be
undertaken and interpreted? Stat Med. 2002;21:1559Y1573.
38. Sterne J, Bradburn M, Egger M. Meta-analysis in Stata. In: Egger M,
Altman D, eds. Systematic Reviews in Health Care: Meta-Analysis in
Context. London: BMJ; 2001.
39. Waite D, Neff J. Profiles of Incarcerated Adolescents in Virginia’s Juvenile
Correctional Centers: Fiscal Years 1999Y2003. Richmond: Virginia
Department of Juvenile Justice; 2004.
40. Bolton A. A Study of the Need for and Availability of Mental Health Services
for Mentally Disordered Jail Inmates and Juveniles in Detention Facilities.
Report to the California State Legislature. Sacramento, CA: Arthur Bolton
Associates; 1976.
41. Wasserman G, McReynolds L, Lucas C, Fisher P, Santos L. The voice
DISC-IV with incarcerated male youths: prevalence of disorder. JAm
Acad Child Adolesc Psychiatry. 2002;41:314Y321.
42. Shelton D. Estimates of Emotional Disorder in Detained and Committed
Youth in the Maryland Juvenile Justice System. Baltimore: University of
Maryland, School of Nursing; 1998.
43. Hollander H, Turner F. Characteristics of incarcerated delinquents:
Relationship between development disorders, environmental and
family factors, and patterns of offense and recidivism. J Am Acad Child
Psychiatry. 1985;24:221Y226.
44. Robertson A, Husain J. Prevalence of Mental Illness and Substance
Abuse Disorders Among Incarcerated Juvenile Offenders. Mississippi State:
Mississippi Department of Public Safety; 2001.
45. Gosden N, Kramp P, Gabrielsen G, Sestoft D. Prevalence of mental
disorders among 15Y17 year old male adolescent remand prisoners in
Denmark. Acta Psychiatr Scand. 2003;107:102Y110.
46. Nicol R, Stretch D, Whitney I, et al. Mental health needs and services for
severely troubled and troubling young people including young offenders
in an NHS region. J Adolesc. 2000;23:243Y261.
47. Ru chki n V, S chw ab-St one M, Koposov R, Vermeire n R, S tei ner H.
Violence exposure, posttraumatic stress, and personality in juve-
nile delinquents. JAmAcadChildAdolescPsychiatry. 2002;41:
322Y329.
48. Chiles J, Miller M, Cox G. Depression in an adolescent delinquent
population. Arch Gen Psychiatry. 1980;37:1179Y1184.
49. Duclos C, Beals J, Novins D, Martin C, Jewett C, Manson S.
Prevalence of common psychiatric disorders among American Indian
adolescent detainees. JAmAcadChildAdolescPsychiatry. 1998;37:
866Y873.
50. Kashani J, Manning G, McKnew D, Cytryn L, Simonds J, Wooderson P.
Depression among incarcerated delinquents. Psychiatry Res. 1980;3:
185Y191.
FAZEL ET AL.
1018 WWW.JAACAP.COM J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 47:9, SEPTEMBER 2008
Copyright @ 2008 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
51. Ulzen T, Hamilton H. The nature and characteristics of psychiatric
comorbidity in incarcerated adolescents. Can J Psychiatry. 1998;43:
57Y63.
52. Dimond C, Misch P. Psychiatric morbidity in children remanded to
prison custodyVa pilot study. J Adolesc. 2002;25:681Y689.
53. Vreugdenhil C, Doreleijers T, Vermeiren R, Wouters L, Van den Brink
W. Psychiatric disorders in a representative sa mple of incarcerated
boys in The Netherlands. JAmAcadChildAdolescPsychiatry. 2004;
43:97Y104.
54. Oliva
´
n Gonzalvo G. Estado de salud y nuticion de mujeres adolescentes
delincuentes [Heal th and nutritional status of delinquent female
adolescents]. Anal Esp Pediatr. 2002;56:116Y120.
55. Abrantes A, Hoffmann N, Anton R. Prevalence of co-occurring disorders
among juveniles committed to detention centers. Int J Offender Ther
Comp Criminol. 2005;49:179Y193.
56. Kuo E, Stoep A, Stewart D. Using the Short Mood and Feelings
Questionnaire to detect depression in detained adolescents. Assessment.
2005;12:374Y383.
57. Lederman C, Dakof G, Larrea M, Li H. Characteristics of adolescent
females in juvenile detention. Int J Law Psychiatry. 2004;27:321Y337.
58. Chitsabesan P, Kroll L, Bailey S, et al. Mental health needs of young
offenders in custody and in the community. Br J Psychiatry. 2006;188:
534Y540.
59. Dixon A, Howie P, Starling J. Psychopathology in female juvenile
offenders. J Child Psychol Psychiatry. 2004;45:1150Y1158.
60. Costello E, Egger H, Angold A. 10-year research update review: the
epidemiology of child and adolescent psychiatric disorders: I. Methods
and public health burden. JAmAcadChildAdolescPsychiatry.
2005;44:972Y986.
61. Kirkbride J, Fearon P, Morgan C, et al . Heteroge neity in incidence
rates of schizophrenia an d other psychotic syndromes: findings from
the 3-center AeSOP study. Arch Gen Psychiatry. 2006;63:250Y258.
62. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The
worldwide prevalence of ADHD: a systematic review and metaregression
analysis. Am J Psychiatry. 2007;164:942Y948.
63. Costello E, Mustillo S, Erkanli A, Keeler G, Angold A. Prevalence and
development of psychiatric disorders in childhood and adolescence. Arch
Gen Psychiatry. 2003;60:837Y844.
64. Costello E, Erkanli A, Angold A. Is there an epidemic of child or
adolescent depression? J Am Acad Child Adolesc Psychiatry. 2006;47:
1263Y1271.
65. Arseneault L, Moffitt T, Caspi A, Taylor P, Silva P. Mental disorders and
violence in a total birth cohort: results from the Dunedin study. Arch Gen
Psychiatry. 2000;57:979Y986.
66. Kasen S, Cohen P, Skodol A, Johnson J, Smailes E, Brook J. Childhood
depression and adult personality disorder: alternative pathways of
continuity. Arch Gen Psychiatry. 2001;58:231Y236.
67. van Lier P, der Ende J, Koot H, Verhulst F. Which better predicts
conduct problems? The relationship of trajectories of conduct problems
with ODD and ADHD symptoms from childhood into adolescence.
J Child Psychol Psychiatry. 2007;48:601Y608.
68. Crowley T, Mikulich S, Ehlers K, Whitmore E, MacDonald M. Validity
of structured clinical evaluations in adolescents with conduct and
substance problems. J Am Acad Child Adolesc Psychiatry. 2001;40:
265Y273.
69. Leese M, Thomas S, Snow L. An ecological study of factors associated
with rates of self-inflicted death in prisons in England and Wales. Int J
Law Psychiatry. 2006;29:355Y360.
70. Glaser J, Greifinger R. Correctional heal th care: a public health
opportunity. Ann Intern Med. 1993;118:139Y145.
71. Raimer B, Stobo J. Health care delivery in the Texas prison system: the
role of academic medicine. JAMA. 2004;292:485Y489.
72. American Academy of Child and Adolescent Psychiatry. Practice
parameter for the assessment and treatment of youth in juvenile
detention and correction facilities. J Am Acad Child Adolesc Psychiatry.
2005;44:1085Y1098.
73. Bailey S, Tarbuck P. Recent advances in the development of screening
tools for mental health in young offenders. Curr Opin Psychiatry. 2006;
19:373Y377.
74. Fazel S, Bains P, Doll H. Substance abuse and dependence in prisoners: a
systematic review. Addiction. 2006;101:181Y191.
75. Fruehwald S, Matschnig T, Koenig F, Bauer P, Frottier P. Suicide in
custody: case-control study. Br J Psychiatry. 2004;185:494Y498.
76. Fazel S, Benning R, Danesh J. Suicides in male prisoners in England and
Wales, 1978-2003. Lancet. 2005;366:1301Y1302.
77. Morgan J, Hawton K. Self-reported suicidal behaviour in juvenile
offenders in custody: prevalence and associated factors. Crisis. 2004;
25:8Y11.
78. Pratt D, Piper M, Appleby L, Webb R, Shaw J. Suicide in recently
released prisoners: a population-based cohort study. Lancet.
2006;368:119Y123.
79. Larsen T, Friis S, Haahr U, et al. Early detection and intervention in first-
episode schizophrenia: a critical review. Acta Psychiatr Scand. 2001;
103:323Y334.
80. Wilens T, Faraone S, Biederman J, Gunawardene S. Does stimulant
therapy of attention-deficit/hyperactivity disorder beget later substance
abuse? A meta-analytic review of the literature. Pediatrics. 2003;111:
179Y185.
MENTAL DISORDERS AMONG ADOLESCENTS IN DETENTION
WWW.JAACAP.COM 1019J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 47:9, SEPTEMBER 2008
    • "This is the most obvious evidence of the negative impact incarceration has on the health of disparities among African Americans and proffers a public health rationale for policy change to reduce this health burden and the distorted reincarceration rate of African American marijuana users. African American male adolescents in particular, are incarcerated on drug use or sales charges disproportionate to their representation in the general population (Levine & Small, 2007; Freudenberg, Moseley, Labriola, et al., 2007) which are more a function of the failures of US educational practices (Ramchand, Morral & Becker, 2009) and psychological difficulties due to socioeconomic factors (Fazel, Doll & Långström, 2008; Lader, Singleton & Meltzer, 2003) more so than addiction and/or a predilection for criminal behavior. Unfortunately the result has been an increased risk for the contraction and spreading of sexually transmitted infections (STIs) such as higher rates of HIV when compared to non-jailed populations (Golzari, Hunt & Anoshiravani, 2006; Teplin, Elkington, McClelland & et al., 2005) This is complicated given that most adolescents are released from jail within a few weeks of arrest, usually without access to community services with a sizable majority being rearrested within a year (Fagan, 1996). "
    [Show abstract] [Hide abstract] ABSTRACT: The intent of this review is to exhibit how and the extent to which federal government marijuana regulation and policy contributes to disparities in arrest, in particular for African Americans of lower socioeconomic standing, thus leading to other negative outcomes including but not limited to poverty, health disparities, increased rates of sexually transmitted infections (STIs) and substance use and abuse. In this discussion, we will focus on the political history that has been institutionally imbued in the American politics and criminal justice system that increases the likelihood that African Americans, especially males, will be linked to stereotypical stigma that is a function of Western culture's socialization of men to accept norms that are not defined by the Torrance T. Stephens and Unity Harris 2 subjective experiences of African Americans. In conclusion, we proffer implications for perspective solutions to this problem including enhancing the quality of educational institutions and reducing educational failure in elementary and high schools, investments to enrich the quality of neighborhood environments and changes in policing and criminal justice policy that targets disproportionally African Americans, the poor and minorities.
    Full-text · Chapter · Jan 2016 · Aggression and Violent Behavior
    • "In 2010, males (83 %) and minority youth (68 %) accounted for a disproportionate amount of those in custody (Hockenberry 2013). More than two-thirds of incarcerated youth have been found to suffer from psychiatric disorders (Teplin et al. 2002), including posttraumatic stress disorder (PTSD; Abram et al. 2004), mood disorders, conduct disorder, psychosis, and attention deficit hyperactivity disorder (ADHD; Fazel et al. 2008), as well as suicidal ideation and attempted suicide (Abram et al. 2008). Approximately half of incarcerated youth suffer from substance use disorders (Abram et al. 2003; Teplin et al. 2002). "
    [Show abstract] [Hide abstract] ABSTRACT: Abstract A growing body of evidence suggests that mindfulness meditation is associated with a number of physiological and psychological benefits in both adult and juvenile populations. Research on mindfulness-based interventions among at-risk and incarcerated youth popula- tions has also shown feasibility as a means of enhancing self-regulation and well-being. This randomized controlled trial examined an 8- to 12-week program in which partic- ipants received individual and group psychotherapy. Partic- ipants in the experimental condition received formal mind- fulness training alongside psychotherapy, while those in the control condition received psychotherapy without mindfulness training. All participants received the group intervention. Participants were recruited from a court- mandated substance abuse group treatment program at a juvenile detention camp in the San Francisco Bay Area. Participants were 35 incarcerated youth (100 % male; 70 % Hispanic; mean age = 16.45). Of these, 27 provided complete pre- and post-treatment assessment data. Mea- sures of mindfulness, locus of control, decision-making, self-esteem, and attitude toward drugs were administered before and after the intervention. Detention camp staff provided behavioral rating points for each participant in the week prior to beginning the study treatment and in the week after completing the intervention. Significant in- creases in self-esteem (p < 0.05) and decision-making skills (p < 0.01) were observed among the entire study sample. Between-group analyses found significantly greater in- creases in self-esteem (p < 0.05) and staff ratings of good behavior (p < 0.05) in the mindfulness treatment group, consistent with prior research. These results suggest a po- tentially important role for mindfulness-based interventions in improving well-being and decreasing recidivism among this at-risk population.
    Full-text · Article · Jul 2015
    • "Subsequently, we examined the combination offen*, and several instruments reported in the papers of Fazel et al. (2008) (i.e., Adolescent Psychopathology Scale [APS], Diagnostic Interview for Children and Adolescents [DICA], Diagnostic Interview Schedule for Children [DISC], Juvenile Detention Interview [JDI], Practical Adolescent Dual Diagnostic Interview [PADDI], Kiddie-Schedule for Affective Disorders and Schizophrenia [K-SADS], Schedules for Clinical Assessment in Neuropsychiatry [SCAN], Structured Clinical Interview for DSM Diagnoses [SCID] and Salford Needs Assessment Schedule for Adolescents [SNASA]), Esmeijer, Veerman, and van Leeuwen (1999) (i.e., Anxiety Disorder Interview Schedule for Children [ADIS], Child and Adolescent Psychiatric Assessment [CAPA], Child Assessment Schedule [CAS], DICA, DISC, Interview Schedule for Children [ISC], K-SADS and Structured Interview for Diagnostic Assessment of Children [SIDAC]), and one additional instrument (i.e., Composite International Diagnostic Interview [CIDI]). Second, reference lists from relevant studies on mental disorders in JSOs (e.g., Seto & Lalumière, 2010; Van Wijk et al., 2006) or juveniles who offended non-sexually (non-JSOs) (e.g., Fazel et al., 2008) were examined for studies that might be included in the current meta-analysis. Third, we contacted researchers who published on the prevalence of mental disorders in juvenile offenders in general, including JSOs, but who did not (yet) report separately on the prevalence of mental disorders in JSOs. "
    [Show abstract] [Hide abstract] ABSTRACT: The purpose of this study was to establish the prevalence of mental disorders in juveniles who sexually offended (JSOs). A meta-analysis was performed based on studies reporting on the prevalence rates of mental disorders in JSOs. Furthermore, differences in mental disorders between JSOs and juveniles who offended non-sexually (non-JSOs) were assessed. In total, 21 studies reporting on mental disorders in 2,951 JSOs and 18,688 non-JSOs were included. In the total group of JSOs, 69% met the criteria for at least one mental disorder; comorbidity was present in 44%. The most common externalizing and internalizing disorders were respectively conduct disorder (CD; 51%) and anxiety disorder (18%). Compared to non-JSOs, JSOs were less often diagnosed with a Disruptive Behavior Disorder (DBD, i.e., CD and/or Oppositional Deviant Disorder [ODD]), an Attention-Deficit/Hyperactivity Disorder (ADHD) and a Substance Use Disorders (SUD). No significant differences were found for internalizing disorders. In conclusion, although the prevalence of externalizing disorders is higher in non-JSOs, mental disorders are highly prevalent in JSOs. Even though results of the current meta-analysis may overestimate prevalence rates (e.g., due to publication bias), screening of JSOs should focus on mental disorders.
    Full-text · Article · Jul 2015
Show more