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

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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. They are usually detained in separate closed facilities or prisons. High prevalence of both undiagnosed and untreated physical and mental health problems have been reported, with current mental disorders estimated to affect 40% to 70% of the adolescents who come into contact with the justice system. Deliberate self-harm and repeat offending are common,and some of these disorders, such as substance misuse and conduct disorder, are risk factors for criminal recidivism. In the United States and the United 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.

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 or data from medical records or interviewed selected populations or those in care and foster homes rather than in detention. Others have reported prevalence information for any psychiatric disorder rather than for specific disorders or used other measures of mental distress than psychiatric diagnoses.

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 10–19 years) met inclusion criteria. Among boys, 3.3% (95% confidence interval [Cl] 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.

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):1010–1019.

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References:

Fazel S, Doll H, Långström N. J Am Acad Child Adolesc Psychiatry. 2008 Sep;47(9):1010-9.