Prevalence, Comorbidity, and Continuity of Psychiatric Disorders in a 15-Year Longitudinal Study of Youths Involved in the Juvenile Justice System

Abstract

Importance: Previous studies have found that one-half to three-quarters of youths detained in juvenile justice facilities have 1 or more psychiatric disorders. Little is known about the course of their disorders as they age.

Objective: To examine the prevalence, comorbidity, and continuity of 13 psychiatric disorders among youths detained in a juvenile justice facility during the 15 years after detention up to a median age of 31 years, with a focus on sex and racial/ethnic differences.

Design, setting, and participants: The Northwestern Juvenile Project is a longitudinal cohort study of health needs and outcomes of 1829 randomly selected youths in a temporary juvenile detention center in Cook County, Illinois. Youths aged 10 to 18 years were interviewed in detention from November 20, 1995, through June 14, 1998. Participants were reinterviewed up to 12 times during the 15-year study period through February 2015, for a total of 16 372 interviews. The sample was stratified by sex, race/ethnicity (Black, Hispanic, and non-Hispanic White), age (10-13 years or 14-18 years), and legal status (processed in juvenile or adult court). Data analysis was conducted from February 2014, when data preparation began, to March 2020.

Exposures: Detention in a juvenile justice facility.

Main outcomes and measures: Psychiatric disorders, assessed by the Diagnostic Interview Schedule for Children, version 2.3 at the baseline interviews. Follow-up interviews were conducted using the Diagnostic Interview Schedule for Children, version IV; the Diagnostic Interview Schedule, version IV; and the World Mental Health Composite International Diagnostic Interview (beginning at the 6-year follow-up interview).

Results: The study included 1829 youths sampled at baseline (1172 males and 657 females; mean [SD] age, 14.9 [1.4] years). Although prevalence and comorbidity of psychiatric disorders decreased as the 1829 participants aged, 52.3% of males and 30.9% of females had at least 1 or more psychiatric disorders 15 years postdetention. Among participants with a disorder at baseline, 64.3% of males and 34.8% of females had a disorder 15 years later. Compared with females, males had 3.37 times the odds of persisting with a psychiatric disorder 15 years after baseline (95% CI, 1.79-6.35). Compared with Black participants and Hispanic participants, non-Hispanic White participants had 1.6 times the odds of behavioral disorders (odds ratio, 1.56; 95% CI, 1.27-1.91 and odds ratio, 1.59; 95% CI, 1.23-2.05, respectively) and greater than 1.3 times the odds of substance use disorders (odds ratio, 1.90; 95% CI, 1.55-2.33 and odds ratio, 1.39; 95% CI, 1.11-1.73, respectively) throughout the follow-up period. Behavioral disorders and substance use disorders were the most prevalent 15 years after detention.

Conclusions and relevance: This study's findings suggest that persistent psychiatric disorders may complicate the transition from adolescence to adulthood, which is already challenging for youths involved in the juvenile justice system, many of whom are from racial/ethnic minority groups and low-income backgrounds. The pediatric health community should advocate for early identification and treatment of disorders among youths in the justice system.

Figure 1.. Sex and Racial/Ethnic Differences in Prevalence of Any Disorder From Detention (Baseline) to 15 Years After Baseline

A, A total of 1167 males and 655 females were included. B, A total of 207 non-Hispanic White males, 386 Hispanic males, and 574 Black males were included. C, A total of 89 non-Hispanic White females, 136 Hispanic females, and 430 Black females were included.

Figure 2.. Sex and Racial/Ethnic Differences in Prevalence of Mood, Anxiety, and Behavioral Disorders From Detention (Baseline) to 15 Years After Baseline

A, A total of 1167 males and 655 females were included. B, A total of 207 non-Hispanic White males, 386 Hispanic males, and 574 Black males were included. C, A total of 89 non-Hispanic White females, 136 Hispanic females, and 430 Black females were included.

Figure 3.. Sex and Racial/Ethnic Differences in Prevalence of Any Substance, Alcohol, and Drug Use Disorders From Detention (Baseline) to 15 Years After Baseline

A, A total of 1167 males and 655 females were included. B, A total of 207 non-Hispanic White males, 386 Hispanic males, and 574 Black males were included. C, A total of 89 non-Hispanic White females, 136 Hispanic females, and 430 Black females were included.

Figure 4.. Odds Ratios for the Association Between Baseline and 15-Year Diagnoses Among Males

A total of 837 males were assessed for a disorder at both baseline and at the 15-year follow-up. The disorder diagnosed at baseline could be the same as or different than the disorder diagnosed 15 years later. Only odds ratios with a significance of P < .05 are shown. Filled circles illustrate that participants with the disorder at baseline had higher odds of being diagnosed with the disorder 15 years later. Open circles illustrate that participants with the disorder at baseline had lower odds of being diagnosed with the disorder 15 years later. Shaded boxes represent disorders in the same diagnostic category. ADHD indicates attention-deficit/hyperactivity disorder; ASPD, antisocial personality disorder; GAD, generalized anxiety disorder; ODD, oppositional defiant disorder; PTSD, posttraumatic stress disorder; and SUD, substance use disorder.

Figure 5.. Odds Ratios for the Association Between Baseline and 15-Year Diagnoses Among Females

A total of 530 females were assessed for a disorder at both baseline and at the 15-year follow-up. The disorder diagnosed at baseline could be the same as or different than the disorder diagnosed 15 years later. Only odds ratios with a significance of P < .05 are shown. Filled circles illustrate that participants with the disorder at baseline had higher odds of being diagnosed with the disorder 15 years later. Open circles illustrate that participants with the disorder at baseline had lower odds of being diagnosed with the disorder 15 years later. Shaded boxes represent disorders in the same diagnostic category. ADHD indicates attention-deficit/hyperactivity disorder; ASPD, antisocial personality disorder; GAD, generalized anxiety disorder; ODD, oppositional defiant disorder; PTSD, posttraumatic stress disorder; and SUD, substance use disorder.