Sunday, December 15, 2002
BETHESDA, MD (NIH) -- Among teens in juvenile detention, nearly two thirds of boys and nearly three quarters of girls have at least one psychiatric disorder, a federally funded study has found. These rates dwarf the estimated 15 percent of youth in the general population thought to have psychiatric illness, placing detained teens on a par with those at highest risk, such as maltreated and runaway youth. Conducted in the Chicago area, the new study is the largest and most methodologically sophisticated of its kind. Linda A. Teplin, Ph.D., Northwestern University, and colleagues, report on their findings in the December, 2002 "Archives of General Psychiatry"
Since previous studies of such youth had yielded inconsistent results, they sought to gauge the true extent of the problem by employing a large, stratified sample, randomized design and standardized diagnostic measures. They assessed psychiatric disorders in 1829 African American, non-Hispanic white and Hispanic teens, ages 10- 18, randomly selected at admission to the Cook County Juvenile Temporary Detention Center, over four years. About 8500 enter the facility each year for pre-trial detention and brief sentences. About 90 percent are males, 88 percent African American, 17 percent Hispanic and 5.6 percent non-Hispanic white. Masters-level psychologists conducted a structured diagnostic interview with the selected teens during a 2-3 hour session following intake, documenting the six-month prevalence rates of various disorders.
About half of the detained teens abused or were addicted to drugs, and more than 40 percent had disruptive behavior disorders: oppositional defiant disorder and conduct disorder. Even when conduct disorder (common in this population) was excluded, nearly 60 percent of males and more than two-thirds of females met diagnostic criteria for, and also were functionally impaired by, one or more mental or substance use disorders. Overall, disorders were more prevalent among older youth and females, more than 20 percent of whom had a major depressive disorder.
Among boys, non-Hispanic whites showed the highest rates of most disorders and African Americans the lowest. The exception was separation anxiety disorder, which was more prevalent among African Americans and Hispanics than among whites. Hispanics had higher rates than African Americans of panic disorder, obsessive-compulsive disorder and substance use other than alcohol or marijuana disorders. The only categories for which boys showed higher rates than girls were a manic episode, psychotic disorders, any substance abuse disorder, and marijuana use disorder. In a departure from the overall pattern, older girls had lower rates of oppositional defiant disorder than younger girls.
"We are especially concerned about the high rates of depression and dysthymia among detained youth -- 17.2 percent of males, 26.3 percent of females," noted Teplin and colleagues.
More than 106,000 teens are currently in custody in U.S. juvenile facilities. As welfare reform, managed care and a shrinking public healthcare system limit access to services, many poor and minority youth with psychiatric disorders may "increasingly fall through the cracks into the juvenile justice system," which is poorly equipped to help them, say the researchers.
The other authors of the study were: Drs. Karen Abram, Gary McClelland and Mina Dulcan, Northwestern University; Dr. Amy Mericle, University of Chicago.