November 11, 2003
Psychiatric Illness, Drug Abuse Common in Jailed Youth
CHICAGO— A study by Feinberg School of Medicine researchers shows that about half of teens in juvenile detention have two or more psychiatric and substance abuse disorders.
The study, conducted by Karen M. Abram, PhD; Linda A. Teplin, PhD; and co-researchers from the Psycho-Legal Studies Program at the medical school, also found that the most common combination was substance abuse disorders and attention deficit hyperactivity disorder (ADHD) or behavioral disorders, which affected almost a third of 1,829 teens examined. Almost half also had anxiety disorders, affective disorders, or both.
More than 1 of 10 teens had a substance abuse disorder and a major mental disorder, such as psychosis, manic episode, or major depressive episode. Among 305 teens with major mental disorders in the current study, more than half of girls and almost three fourths of boys also had a substance abuse disorder.
“Treating these youth is a real challenge,” Dr. Abram said. “Their disorders may get them into trouble. But detention centers were never designed to be mental hospitals.”
Results of the study, conducted at the Cook County Juvenile Temporary Detention Center in Chicago, were published in the November issue of Archives of General Psychiatry. The Cook County facility was selected because it is typical of other urban detention centers nationwide.
Mental health professionals speculated for years that because of failures in the mental health system, many adolescents with serious psychiatric disorders are arrested instead of treated. An earlier study by the Psycho-Legal Studies group found that even after excluding conduct disorder (symptoms of which include delinquent behaviors), approximately 60 percent of males and 70 percent of females in juvenile detention have at least one psychiatric disorder. Substance abuse was the most frequent disorder, affecting 50 percent of the sample. These rates of disorder far exceed those of teens in the community.
Dr. Abram estimated that nationwide as many as 47,000 detained juveniles have two or more types of psychiatric disorder and more than 12,000 have both a major mental disorder and a substance abuse disorder. “Comorbidity of psychiatric disorders is the rule, not the exception,” she said.
On an average day, more than 106,000 teens are in custody in U.S. juvenile facilities, and of these, more than 60 percent are racial or ethnic minorities and from low-income families. Thus, psychiatric disorders in detained adolescents are a significant health disparities issue, Dr. Abram said.
The authors suggest that mental health professionals must collaborate with the juvenile justice system to better screen detainees for psychiatric problems, divert youths with major mental disorders who are not community threats to treatment facilities on arrest, and reduce barriers to mental health services.
Dr. Abram is assistant professor of psychiatry and behavioral sciences. Dr. Teplin is Owen L. Coon Professor of Psychiatry and Behavioral Sciences and director of the Psycholegal Studies Program. Their co-authors on the study were Gary M. McClelland, PhD, research assistant professor of psychiatry and behavioral sciences, and Mina K. Dulcan, MD, professor of psychiatry and behavioral sciences and head of child and adolescent psychiatry at Children’s Memorial Hospital.
This study was supported by grants from the National Institutes of Health, Substance Abuse and Mental Health Services Administration, Centers for Disease Control and Prevention, Office of Juvenile Justice and Delinquency Prevention, Robert Wood Johnson Foundation, William T. Grant Foundation, and a consortium of other agencies.