An Updated Systematic Review and Meta-regression Analysis: Mental Disorders Among Adolescents in Juvenile Detention and Correctional Facilities

Abstract

Objective: To synthesize evidence on the prevalence of mental disorders in adolescents in juvenile detention and correctional facilities and examine sources of heterogeneity between studies. Method: Electronic databases and relevant reference lists were searched to identify surveys published from January 1966 to October 2019 that reported on the prevalence of mental disorders in unselected populations of detained adolescents. Data on the prevalence of a range of mental disorders (psychotic illnesses, major depression, attention-deficit/hyperactivity disorder [ADHD], conduct disorder, and posttraumatic stress disorder [PTSD]) along with predetermined study characteristics were extracted from the eligible studies. Analyses were reported separately for male and female adolescents, and findings were synthesized using random-effects models. Potential sources of heterogeneity were examined by meta-regression and subgroup analyses. Results: Forty-seven studies from 19 countries comprising 28,033 male and 4,754 female adolescents were identified. The mean age of adolescents assessed was 16 years (range, 10-19 years). In male adolescents, 2.7% (95% CI 2.0%-3.4%) had a diagnosis of psychotic illness; 10.1% (95% CI 8.1%-12.2%) major depression; 17.3% (95% CI 13.9%-20.7%) ADHD; 61.7% (95% CI 55.4%-67.9%) conduct disorder; and 8.6% (95% CI 6.4%-10.7%) PTSD. In female adolescents, 2.9% (95% CI 2.4%-3.5%) had a psychotic illness; 25.8% (95% CI 20.3%-31.3%) major depression; 17.5% (95% CI 12.1%-22.9%) ADHD; 59.0% (95% CI 44.9%-73.1%) conduct disorder; and 18.2% (95% CI 13.1%-23.2%) PTSD. Metaregression found higher prevalences of ADHD and conduct disorder in investigations published after 2006. Female adolescents had higher prevalences of major depression and PTSD than male adolescents. Conclusion: Consideration should be given to reviewing whether health care services in juvenile detention can address these levels of psychiatric morbidity.

Mental disorders among adults formerly in out-of-home care: a systematic review and meta-analysis of longitudinal studies

“…However, results varied across individual studies and indicated low to high heterogeneity between effect size estimates, mainly due to methodological differences between studies (i.e., setting of care, time period of prevalence, and study design). Due to various moderator variables, our metaanalysis found comparable levels of heterogeneity to those in previous meta-analyses of both child welfare and juvenile justice samples [3,4]. The elevated rates of mental disorders among adults previously in out-of-home care may be explained by the use of samples in the stage of young adulthood (18-25 years) in eight studies [63,65,67,69,70,72,76,77], compared with the highest mean age of 72 years in the study sample of Fernandez et al [78].…”

“…Millions of children and adolescents worldwide are placed in out-of-home care, with rates ranging from approximately 0.5-1% between countries [1,2]. The prevalence of mental disorders is high in these children and adolescents [3,4], as they face various challenges related to mental disorders in the transition period from leaving care to adulthood (e.g., homelessness, adult mental disorders, or unemployment; [5][6][7]). To date, the extent of the association between placement in childhood out-of-home care and the occurrence of adult mental disorders remains unclear.…”

Evaluation of the Executive Functioning and Psychological Adjustment of Child-to-Parent Offenders: Epidemiology and Quantification of Harm

“…Moreover, the clinical profiles ruled out two key malingering strategies (Vilariño et al, 2013;Rogers, 2018): indiscriminate grouping of symptoms (no reported harm in all of the disorders; in fact, hypochondriasis, depression, psychasthenia, schizophrenia, hypomania, and social introversion report normality) and symptom severity (participants reported no severe disorder, T < 90). In short, the systematic tendency to malinger was ruled out in CPOs, i.e., a diagnostic criterion for CD and a differential diagnosis for PTSD in forensic setting (American Psychiatric Association, 2000, a diagnosis with significant rates [61.7% (95% CI 55.4-67.9%) of CD and 8.6% (95% CI 6.4-10.7%) of PTSD] among juvenile offenders (Beaudry et al, 2021). Likewise, systematic defensiveness (defensiveness may consist in denial of symptoms and/or the adoption of desirable characteristicssocial desirability-to mask an unfavorable image; Arce et al, 2015;Rogers, 2018) was ruled out in CPOs: L, K, and the F-K index ruled out the suspicion of defensiveness.…”

“…Clinically, CPOs experience more symptoms on the basic clinical dimensions than the normative population, but only report clinical deterioration in psychopathic deviation (unreliable, egocentric, and irresponsible; unable to learn from experience and to plan ahead; problems with family members and authority; anger toward others; and problematic interpersonal relations in large interactions and under stress); and moderate deterioration in hysteria (naive, self-centered, denying any problem, exhibitionist, extroverted, and superficial) and paranoia (highly sensitive to criticism and to personalize the actions of others toward themselves). Furthermore, CPOs report more clinical maladjustment than other juvenile justice samples, which is characterized by psychological problems (Baum et al, 2009;Marcos et al, 2020;Beaudry et al, 2021). Hence, the population of CPOs are a clinical population experiencing more deterioration than other samples of juvenile justice.…”

“…Remarkably, the contents of treatments for CPOs have been barely assessed, even though CPO interventions should be the primary objective according to judicial sentences. Of the array of needs identified in the literature on adult and juvenile violence and delinquency, psychological adjustment (Mayorga et al, 2020;Beaudry et al, 2021) and cognitive competency (Arias et al, 2020;Beelmann and Lösel, 2020) in CPOs have received little attention, and the results on CPV are inconsistent (Simmons et al, 2018).…”