Study finds psychiatric disorders persist 15 years after youth are detained

Research from Northwestern Medicine shows nearly two-thirds of males and more than one-third of females with one or more existing psychiatric disorders when they entered detention, still had a disorder 15 years later.

The findings are significant because mental health struggles add to the existing racial, ethnic and economic disparities as well as academic challenges from missed school, making a successful transition to adulthood harder to attain.

"Kids get into trouble during adolescence. Those from wealthier families also use drugs and get into fights. But these situations are most often handled informally by the school and parent, and don't culminate in arrest and detention," said lead author Linda Teplin, Owen L. Coon Professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine.

"These are not necessarily bad kids, but they have many strikes against them. Physical abuse, sexual abuse and neglect are common. These experiences can precipitate depression. Incarceration should be the last resort," said Teplin, also a faculty associate with the University's Institute for Policy Research.

The unprecedented longitudinal study reports on the prevalence, persistence and patterns of behavioral and psychiatric disorders in youth up to 15 years after they leave detention and whether outcomes vary by sex and race/ethnicity.

Key findings show that despite a decrease in disorders over time, especially among females, the prevalence of psychiatric disorders 15 years later was still substantially higher than the general population.

Males fared significantly worse overall. Among youth with a disorder in detention, 64.3% of males and 34.8% of females had one or more disorders 15 years later. Compared with females, males had more than three times the odds of persisting with a psychiatric disorder over time.

"This may be because females, as they age, became more family-focused. Positive social connections -- having a stable partner, raising children, establishing a family -- are conducive to positive mental health," said study co-author Karen Abram, professor of psychiatry and behavioral sciences at Feinberg School of Medicine and associate director of the Program in Health Disparities and Public Policy.

Fifteen years after youth left detention, disruptive behavior and substance abuse disorders were the most common. Non-Hispanic whites had 1.6 times greater odds of having behavioral disorders and more than 1.3 times greater odds of having substance use disorders throughout the follow-up period compared with African Americans and Hispanics.

"An unanticipated finding of the study was the lower rate of substance use disorders in racial/ethnic minorities, despite the disproportionate incarceration of these groups," Teplin said.

"Clearly, we must expand mental health services during detention and when these youth return to their communities. We must also encourage pediatricians and educators to advocate for early identification and treatment of psychiatric disorders," Teplin said. "Unfortunately, in the U.S., school systems are funded by local governments. Thus, our children may be sentenced to a life of inequity because of their zip code."

"Prevalence, Comorbidity, and Continuity of Psychiatric Disorders in Delinquent Youth After Detention: A 15-Year Prospective Longitudinal Study," will publish in JAMA Pediatrics at 11 a.m. EST, April 5, 2021.

In addition to Teplin and Abram, Northwestern co-authors include Lauren M. Potthoff, David A. Aaby, Leah J. Welty and Mina K. Dulcan.

About the Northwestern Juvenile Project

Seeing a gap in the research literature about the health needs and outcomes of juvenile justice youth, the Northwestern Juvenile Project, a Northwestern Medicine initiative, has been interviewing a randomly selected sample of 1,800 youth since the mid-1990s.

To date, the study has compiled epidemiological data from 16,372 face-to-face interviews, conducted from a median age of 15 at detention through the median age of 31. The researchers assess 13 psychiatric disorders and track the prevalence, patterns of multiple disorders and the continuity of disorders over time. The study also focuses on gender and racial/ethnic differences.

Project data has been used to analyze health issues, including firearm violence, mortality, drug abuse and HIV/AIDS risk behaviors. Project data also found that few participants achieved positive outcomes in adulthood, such as finishing high school or finding steady employment.

Support for the Northwestern Juvenile Project has been provided by 22 federal agencies and private foundations, including the Department of Justice, National Institutes of Health, and Substance Abuse and Mental Health Administration.

The National Institute of Justice, the Centers for Disease Control and Prevention and three institutes at the National Institutes of Health are funding the new intergenerational component of the landmark study, allowing investigators to interview the original study participants along with their adolescent children.