Disclosures: One study author reports receiving royalties on professional books from the American Psychiatric Association Publishing. The other authors report no relevant financial disclosures. Dir reports receiving grants from the Indiana Clinical and Translational Sciences Institute outside the submitted work. Aalsma reports no relevant financial disclosures.
April 06, 2021
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Persistent psychiatric disorders impact outcomes for youths in juvenile justice system

Disclosures: One study author reports receiving royalties on professional books from the American Psychiatric Association Publishing. The other authors report no relevant financial disclosures. Dir reports receiving grants from the Indiana Clinical and Translational Sciences Institute outside the submitted work. Aalsma reports no relevant financial disclosures.
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Youth with persistent psychiatric disorders who were detained in a juvenile justice facility exhibited complications during the transition from adolescence to adulthood, according to study results published in JAMA Pediatrics.

“Many studies have documented the high prevalence of psychiatric disorders in detained youth,” Linda A. Teplin, PhD, of the department of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine, told Healio Psychiatry. “However, far less is known about them after they leave detention. We designed our study to address this key omission in the literature.”

Teplin infographic quote

Teplin and colleagues conducted the current longitudinal cohort study to assess the prevalence, comorbidity and continuity of 13 psychiatric disorders among 1,829 randomly selected youths detained in a temporary juvenile justice facility across 15 years following detention up to a median age of 31 years. They focused on sex and racial/ethnic differences among study participants, who were aged 10 to 18 years and were interviewed in detention between Nov. 20, 1995, and June 14, 1998. The researchers reinterviewed them up to 12 times across the 15 years up until February 2015 and conducted 16,372 interviews.

Psychiatric disorders evaluated via the Diagnostic Interview Schedule for Children, version 2.3 at baseline interviews served as a main outcome. To conduct follow-up interviews, the researchers used the Diagnostic Interview Schedule for Children, version IV; the Diagnostic Interview Schedule, version IV; and the World Mental Health Composite International Diagnostic Interview Schedule beginning at the 6-year follow-up interview.

Results showed a decrease in psychiatric disorder prevalence and comorbidity as participants aged; however, 52.3% of male participants and 30.9% of female participants had one or more psychiatric disorder 15 years post-detention. A total of 64.3% of male participants and 34.8% of female participants had disorders 15 years later among those with a disorder at baseline. Male participants had 3.37 times the odds vs. female participants of persisting with a psychiatric disorder 15 years after baseline. Non-Hispanic white participants had 1.6 times the odds of behavioral disorders and more than 1.3 times the odds of substance use disorders vs. Black participants and Hispanic participants throughout the follow-up period. At 15 years post-detention, behavioral disorders and substance use disorders were the most prevalent.

“Youth in the juvenile justice system are disproportionately racial/ethnic minorities, most are poor and many end up in the juvenile justice system because they do not receive needed mental health services,” Teplin said. “Thus, they fall between the cracks of the systems into the juvenile justice net, and, unfortunately, there is then a well-trodden path from juvenile justice to adult jails and prisons. The implications of these findings suggest a need to improve the systems that provide psychiatric services to youth in schools, the child welfare system, the educational system and the mental health system, as well as to have juvenile detention be the system of last resort for kids.”

In a related editorial, Matthew C. Aalsma, PhD, and Ally Dir, PhD, of the Adolescent Behavioral Health Research Program at Indiana University School of Medicine, outlined a path forward for research in this area.

“It is helpful that Teplin and colleagues highlighted the fact that some individuals who were followed up longitudinally in the Northwestern Juvenile Project did not continue to have a psychiatric disorder burden,” Aaslma and Dir wrote. “It is unclear which interventions or resources are necessary for psychiatric disorder resistance. Nonetheless, investment in longitudinal research projects, such as the Teplin [and colleagues] study, are important to inform the development of future interventions for vulnerable populations. Advocates for youths involved in the juvenile justice system may be encouraged to continue that advocacy and evaluate how best to improve outcomes among this vulnerable population.”