Comorbid Psychiatric Disorders in Youth in Juvenile Detention

Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 710 N. Lakeshore Drive, Chicago, IL 60612, USA.
Archives of General Psychiatry (Impact Factor: 14.48). 12/2003; 60(11):1097-108. DOI: 10.1001/archpsyc.60.11.1097
Source: PubMed


To estimate 6-month prevalence of comorbid psychiatric disorders among juvenile detainees by demographic subgroups (sex, race/ethnicity, and age).
Epidemiologic study of juvenile detainees. Master's level clinical research interviewers administered the Diagnostic Interview Schedule for Children Version 2.3 to randomly selected detainees.
A large temporary detention center for juveniles in Cook County, Illinois (which includes Chicago and surrounding suburbs).
Randomly selected, stratified sample of 1829 African American, non-Hispanic white, and Hispanic youth (1172 males, 657 females, aged 10-18 years) arrested and newly detained.
Diagnostic Interview Schedule for Children.
Significantly more females (56.5%) than males (45.9%) met criteria for 2 or more of the following disorders: major depressive, dysthymic, manic, psychotic, panic, separation anxiety, overanxious, generalized anxiety, obsessive-compulsive, attention-deficit/hyperactivity, conduct, oppositional defiant, alcohol, marijuana, and other substance; 17.3% of females and 20.4% of males had only one disorder. We also examined types of disorder: affective, anxiety, substance use, and attention-deficit/hyperactivity or behavioral. The odds of having comorbid disorders were higher than expected by chance for most demographic subgroups, except when base rates of disorders were already high or when cell sizes were small. Nearly 14% of females and 11% of males had both a major mental disorder (psychosis, manic episode, or major depressive episode) and a substance use disorder. Compared with participants with no major mental disorder (the residual category), those with a major mental disorder had significantly greater odds (1.8-4.1) of having substance use disorders. Nearly 30% of females and more than 20% of males with substance use disorders had major mental disorders. Rates of some types of comorbidity were higher among non-Hispanic whites and older adolescents.
Comorbid psychiatric disorders are a major health problem among detained youth. We recommend directions for research and discuss how to improve treatment and reduce health disparities in the juvenile justice and mental health systems.

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    • "Yet, the findings may inform practitioners' understandings about this sample of youth on probation. For example, highlighting the unmet needs of youth on probation that are associated with their risk factors could provide practitioners with indicators for service provision to reduce their delinquent behavior (Abram, Teplin, McClelland, and Dulcan 2003; Lipsey and Cullen 2007; Lipsey, Wilson, and Cothern 2000; Nissen 2006; Teplin et al. 2002). "

    Full-text · Article · Dec 2015
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    • "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). Among a sample of over 7000 incarcerated youth surveyed in 2003, 44 % reported being under the influence of alcohol or drugs during the offense that led to their detainment (Sedlak and Bruce 2010). "
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    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.
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    • "However, comorbidity with mental health problems might be greater for JJ girls who have substance use problems: 29 % of females with substance use disorders in one study also had at least one major mental health disorder. The comorbidity rate was only 21 % for males (Abram et al. 2003). Together, the research in this area indicates that substance use is the most significant co-occurring problem for girls in the JJ system. "
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    ABSTRACT: The proportion of the juvenile justice population that comprises females is increasing, yet few evidence-based models have been evaluated and implemented with girls in the juvenile justice system. Although much is known about the risk and protective factors for girls who participate in serious delinquency, significant gaps in the research base hamper the development and implementation of theoretically based intervention approaches. In this review, we first summarize the extant empirical work about the predictors and sequelae of juvenile justice involvement for girls. Identified risk and protective factors that correspond to girls' involvement in the juvenile justice system have been shown to largely parallel those of boys, although exposure rates and magnitudes of association sometimes differ by sex. Second, we summarize findings from empirically validated, evidence-based interventions for juvenile justice-involved youths that have been tested with girls. The interventions include Functional Family Therapy, Multisystemic Therapy, Multidimensional Family Therapy, and Treatment Foster Care Oregon (formerly known as Multidimensional Treatment Foster Care). We conclude that existing evidence-based practices appear to be effective for girls. However, few studies have been sufficiently designed to permit conclusions about whether sex-specific interventions would yield any better outcomes for girls than would interventions that already exist for both sexes and that have a strong base of evidence to support them. Third, we propose recommendations for feasible, cost-efficient next steps to advance the research and intervention agendas for this under-researched and underserved population of highly vulnerable youths.
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