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Health See other Health Articles Title: Persistent Psychiatric Disorders Linked to Juvenile Detention October 9, 2012 — Although the prevalence rates of many mental problems decrease as adolescents and teens age after having been incarcerated, these disorders continue to persist in a "substantial proportion" of juveniles, new research suggests. A study of more than 1800 youth showed that 5 years after being detained in a Chicago, Illinois, juvenile detention center, more than 45% of the boys and almost 30% of the girls had at least 1 psychiatric disorder. The most common problem for all the youth and for the subgroup of boys only was a substance use disorder (SUD). However, major depression was also a common disorder over time for the girls. Lead author Linda Teplin, PhD, said in a release that some of the persistent disorders found in this study were 3 times more prevalent than in the general population. Dr. Linda Teplin "I was surprised about the prevalence of disorders when these kids entered detention — about three fourths of the girls and about two thirds of the boys," Dr. Teplin, professor of psychiatry and behavioral sciences at Northwestern University School of Medicine in Chicago, told Medscape Medical News. "I was also surprised that the disorders persisted. One would hope that the kids would come in with a problem but then straighten out later. But that seemed not to be the case. Some kids got better, but a lot of kids didn't." She noted that the study's take-home message is that the community needs to be responsive to these youth when they return home. "And perhaps then we can implement preventive interventions and treatments so the kids don't get caught in a revolving door between the community and detention centers," said Dr. Teplin. The study is published in the October issue of the Archives of General Psychiatry. Vulnerable Population According to the investigators, incarcerated juveniles often have 1 or more persistent mental disorders. "Risk factors for psychiatric disorders are common among delinquent youth: maltreatment, dysfunctional families, family substance abuse, and brain injury," they write. "Because delinquent youth have few protective factors to offset these risks, many are vulnerable to continued psychiatric morbidity as they age." Still, the researchers note that this is the first longitudinal study to track psychiatric disorders in youth after they leave juvenile detention. Dr. Teplin and her colleagues had previously conducted a series of studies that looked at adults in jail, many of whom had first gotten into trouble with the law as kids. Many of these adults had also developed symptoms of psychiatric disorders when they were young. "So the logical next step, since we had studied men in jail and women in jail, was to look at kids in detention," she said. "For 37 years, I've been studying incarcerated people and looking at people who fall through the cracks into the criminal justice net." SUDs Common As part of the Northwestern Juvenile Project, the investigators conducted up to 5 interviews with 1829 youth between the ages of 10 and 18 years (64% boys) who were detained in the Cook County Juvenile Temporary Detention Center (CCJTDC) between November 1995 and June 1998. "The CCJTDC is used for pretrial detention and for offenders sentenced for fewer than 30 days," report the investigators. The ethnicity breakdown of the study population was 54% black, 29% Hispanic, 16% white, and 1% considered "other." The Diagnostic Interview Schedule for Children was administered to all participants at baseline (upon leaving detention) and during follow-ups during the next 5 years to assess for the presence of any disorders, including SUDs. Results showed that 5 years after baseline, 1 or more "psychiatric disorders with associated impairment" were found in 46.5% of the boys and 29% of the girls; and "psychiatric disorders without impairment" were found in 51.7% and 40.8%, respectively. SUDs were the most common disorder found in the whole study population (28% of the boys and 13.5% of the girls). Although the prevalence generally decreased over time, SUDs were still the most common problem for the boys 5 years after baseline (adjusted odds ratio [AOR], 2.61 vs the girls; 95% confidence interval [CI], 1.96 - 3.47). SUDs were also more commonly found in whites (AOR, 1.96) and Hispanics (AOR, 1.59) than in blacks. "This is exactly the opposite of the patterns of incarceration," said Dr. Teplin in the release. She added that in 2010, blacks were incarcerated 7 times more than whites. Mood, Anxiety Disorders In addition to SUDs, the girls also struggled with major depression (AOR, 1.59; 95% CI, 1.22 - 2.08), which was more prevalent in their subgroup at the 5-year follow-up than in the boys (10.2% vs 6.4%, respectively). However, in the total population, prevalence rates for all mood disorders except mania decreased over time. For every additional year, there was a decrease in the odds of major mood disorder (AOR, 0.89), major depression (AOR, 0.91), and dysthymia (AOR, 0.57). In the category of anxiety disorders, the odds increased slightly for panic disorder for all participants (AOR, 1.30 per year) and for "any anxiety disorder" for the girls (AOR, 1.42). However, Hispanics had more than twice the odds of any anxiety disorder (AOR, 2.18) and posttraumatic stress disorder (AOR, 2.82) than did whites; and they had more than 3 times the odds of panic disorder compared with blacks (AOR, 3.82). Blacks were more likely to have posttraumatic stress disorder than were whites (AOR, 1.84), whereas whites were more likely to have panic disorder than were blacks (AOR, 3.56). For the entire population, the prevalence of any disruptive behaviors decreased. And over time, this decrease was faster for the girls than for the boys. Still, the highest rates of this type of disorder were found in whites (AOR, 2.34 vs blacks; AOR, 1.56 vs Hispanics). "Although prevalence rates of most psychiatric disorders declined as youth aged, a substantial proportion of delinquent youth continue to have disorders," the investigators write. Policy Change Their recommendations for future health policies include the following: Focusing on delinquent males, especially because several successful female-focused programs have already been implemented; Creating interventions for males that specifically focus on substance use and disruptive behavior; and Treating SUDs in correctional facilities and after release for all individuals. The investigators note that the Congressional Budget Office has projected that 30 million nonelderly residents of the United States will be uninsured in 2016. "Therefore, we must improve services and access to care in corrections and in the community, where virtually all detained juveniles and incarcerated adults will eventually return." Dr. Teplin said in the release that "people think these kids are locked up forever," but the average stay is only around 2 weeks. "Many of the youths in detention aren't bad kids, they're just poor and may not receive needed services," she said. "Obviously, it's better to provide community services than to build correctional facilities. Otherwise, the lack of services perpetuates the revolving door between the community and corrections." The study was supported by several organizations, which are listed in the original article. Dr. Teplin and 3 of the other 4 study authors have disclosed no financial relationships. The remaining author reports receiving book royalties from American Psychiatric Publishing, being a consultant for Care Management Technologies, Inc, and being on the Attention-Deficit/Hyperactivity Disorder and Reader Disorder and Strattera advisory boards at Eli Lilly and Company. Arch Gen Psychiatry. 2012;69:1031-1043. Abstract Post Comment Private Reply Ignore Thread
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