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. 2021 Jan;60(1):46-60.
doi: 10.1016/j.jaac.2020.01.015. Epub 2020 Feb 5.

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

Gabrielle Beaudry  1 , Rongqin Yu  1 , Niklas Långström  2 , Seena Fazel  3
Affiliations

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

Gabrielle Beaudry et al. J Am Acad Child Adolesc Psychiatry. 2021 Jan.

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. Meta-regression 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.

Keywords: PTSD; criminal justice; detention; mental disorders; systematic review.

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Figures

Figure 1
Figure 1
Flow Diagram Detailing the Search Strategy for the Updated Systematic Review (1966–2019) Note:PTSD = posttraumatic stress disorder.
Figure 2
Figure 2
Prevalence of Specific Mental Disorders Among Incarcerated Male and Female Adolescents Note:Error bars represent 95% CIs of prevalence. Smaller studies (n < 100) were aggregated. Subtotal is pooled prevalence estimate based on random effects models. ES = prevalence estimate.
Figure 2
Figure 2
Prevalence of Specific Mental Disorders Among Incarcerated Male and Female Adolescents Note:Error bars represent 95% CIs of prevalence. Smaller studies (n < 100) were aggregated. Subtotal is pooled prevalence estimate based on random effects models. ES = prevalence estimate.
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