The health of adolescents in detention: a global scoping review

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Abstract

Adolescents detained within the criminal justice system are affected by complex health problems, health-risk behaviours, and high rates of premature death. We did a global synthesis of the evidence regarding the health of this population. We searched Embase, PsycINFO, Education Resources Information Center, PubMed, Web of Science, CINCH, Global Health, the Cochrane Database of Systematic Reviews, the Campbell Library, the National Criminal Justice Reference System Abstract Database, and Google Scholar for peer-reviewed journal articles, including reviews, that reported the prevalence of at least one health outcome (physical, mental, sexual, infectious, and neurocognitive) in adolescents (aged <20 years) in detention, and were published between Jan 1, 1980, and June 30, 2018. The reference lists of published review articles were scrutinised for additional relevant publications. Two reviewers independently screened titles and abstracts, and three reviewed full texts of relevant articles. The protocol for this Review was registered with PROSPERO (CRD42016041392). 245 articles (204 primary research articles and 41 reviews) were included, with most primary research (183 [90%]) done in high-income countries. A high lifetime prevalence of health problems, risks, and conditions was reported in detained adolescents, including mental disorders (0–95%), substance use disorders (22–96%), self-harm (12–65%), neurodevelopmental disabilities (2–47%), infectious diseases (0–34%), and sexual and reproductive conditions (pregnant by age 19 years 20–37%; abnormal cervical screening test result 16%). Various physical and mental health problems and health-risk behaviours are more common among adolescents in detention than among their peers who have not been detained. As the social and structural drivers of poor health overlap somewhat with factors associated with exposure to the criminal justice system, strategies to address these factors could help to reduce both rates of adolescent detention and adolescent health inequalities. Improving the detection of mental and physical disorders, providing appropriate interventions during detention, and optimising transitional health care after release from detention could improve the health outcomes of these vulnerable young people.

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Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis

Robert W Aldridge, Alistair Story, Stephen Hwang … (2018)

Summary Background Inclusion health focuses on people in extremely poor health due to poverty, marginalisation, and multimorbidity. We aimed to review morbidity and mortality data on four overlapping populations who experience considerable social exclusion: homeless populations, individuals with substance use disorders, sex workers, and imprisoned individuals. Methods For this systematic review and meta-analysis, we searched MEDLINE, Embase, and the Cochrane Library for studies published between Jan 1, 2005, and Oct 1, 2015. We included only systematic reviews, meta-analyses, interventional studies, and observational studies that had morbidity and mortality outcomes, were published in English, from high-income countries, and were done in populations with a history of homelessness, imprisonment, sex work, or substance use disorder (excluding cannabis and alcohol use). Studies with only perinatal outcomes and studies of individuals with a specific health condition or those recruited from intensive care or high dependency hospital units were excluded. We screened studies using systematic review software and extracted data from published reports. Primary outcomes were measures of morbidity (prevalence or incidence) and mortality (standardised mortality ratios [SMRs] and mortality rates). Summary estimates were calculated using a random effects model. Findings Our search identified 7946 articles, of which 337 studies were included for analysis. All-cause standardised mortality ratios were significantly increased in 91 (99%) of 92 extracted datapoints and were 11·86 (95% CI 10·42–13·30; I 2=94·1%) in female individuals and 7·88 (7·03–8·74; I 2=99·1%) in men. Summary SMR estimates for the International Classification of Diseases disease categories with two or more included datapoints were highest for deaths due to injury, poisoning, and other external causes, in both men (7·89; 95% CI 6·40–9·37; I 2=98·1%) and women (18·72; 13·73–23·71; I 2=91·5%). Disease prevalence was consistently raised across the following categories: infections (eg, highest reported was 90% for hepatitis C, 67 [65%] of 103 individuals for hepatitis B, and 133 [51%] of 263 individuals for latent tuberculosis infection), mental health (eg, highest reported was 9 [4%] of 227 individuals for schizophrenia), cardiovascular conditions (eg, highest reported was 32 [13%] of 247 individuals for coronary heart disease), and respiratory conditions (eg, highest reported was 9 [26%] of 35 individuals for asthma). Interpretation Our study shows that homeless populations, individuals with substance use disorders, sex workers, and imprisoned individuals experience extreme health inequities across a wide range of health conditions, with the relative effect of exclusion being greater in female individuals than male individuals. The high heterogeneity between studies should be explored further using improved data collection in population subgroups. The extreme health inequity identified demands intensive cross-sectoral policy and service action to prevent exclusion and improve health outcomes in individuals who are already marginalised. Funding Wellcome Trust, National Institute for Health Research, NHS England, NHS Research Scotland Scottish Senior Clinical Fellowship, Medical Research Council, Chief Scientist Office, and the Central and North West London NHS Trust.

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Psychiatric disorders in youth in juvenile detention.

Linda Teplin, Karen Abram, Gary M. McClelland … (2002)

Given the growth of juvenile detainee populations, epidemiologic data on their psychiatric disorders are increasingly important. Yet, there are few empirical studies. Until we have better epidemiologic data, we cannot know how best to use the system's scarce mental health resources. Using the Diagnostic Interview Schedule for Children version 2.3, interviewers assessed a randomly selected, stratified sample of 1829 African American, non-Hispanic white, and Hispanic youth (1172 males, 657 females, ages 10-18 years) who were arrested and detained in Cook County, Illinois (which includes Chicago and surrounding suburbs). We present 6-month prevalence estimates by demographic subgroups (sex, race/ethnicity, and age) for the following disorders: affective disorders (major depressive episode, dysthymia, manic episode), anxiety (panic, separation anxiety, overanxious, generalized anxiety, and obsessive-compulsive disorders), psychosis, attention-deficit/hyperactivity disorder, disruptive behavior disorders (oppositional defiant disorder, conduct disorder), and substance use disorders (alcohol and other drugs). Nearly two thirds of males and nearly three quarters of females met diagnostic criteria for one or more psychiatric disorders. Excluding conduct disorder (common among detained youth), nearly 60% of males and more than two thirds of females met diagnostic criteria and had diagnosis-specific impairment for one or more psychiatric disorders. Half of males and almost half of females had a substance use disorder, and more than 40% of males and females met criteria for disruptive behavior disorders. Affective disorders were also prevalent, especially among females; more than 20% of females met criteria for a major depressive episode. Rates of many disorders were higher among females, non-Hispanic whites, and older adolescents. These results suggest substantial psychiatric morbidity among juvenile detainees. Youth with psychiatric disorders pose a challenge for the juvenile justice system and, after their release, for the larger mental health system.

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Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in-school studies.

Philip A. May, J. Gossage, Wendy Kalberg … (2009)

Researching the epidemiology and estimating the prevalence of fetal alcohol syndrome (FAS) and other fetal alcohol spectrum disorders (FASD) for mainstream populations anywhere in the world has presented a challenge to researchers. Three major approaches have been used in the past: surveillance and record review systems, clinic-based studies, and active case ascertainment methods. The literature on each of these methods is reviewed citing the strengths, weaknesses, prevalence results, and other practical considerations for each method. Previous conclusions about the prevalence of FAS and total FASD in the United States (US) population are summarized. Active approaches which provide clinical outreach, recruitment, and diagnostic services in specific populations have been demonstrated to produce the highest prevalence estimates. We then describe and review studies utilizing in-school screening and diagnosis, a special type of active case ascertainment. Selected results from a number of in-school studies in South Africa, Italy, and the US are highlighted. The particular focus of the review is on the nature of the data produced from in-school methods and the specific prevalence rates of FAS and total FASD which have emanated from them. We conclude that FAS and other FASD are more prevalent in school populations, and therefore the general population, than previously estimated. We believe that the prevalence of FAS in typical, mixed-racial, and mixed-socioeconomic populations of the US is at least 2 to 7 per 1,000. Regarding all levels of FASD, we estimate that the current prevalence of FASD in populations of younger school children may be as high as 2-5% in the US and some Western European countries. (c) 2009 Wiley-Liss, Inc.

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Author and article information

Contributors

Rohan Borschmann

Prof Nathan Hughes

Kathryn Snow

Emily Stockings

Nicole T M Hill

Prof Jane Hocking

Alexander Love

Prof Seena Fazel

Cheneal Puljević

Jo Robinson

Prof Stuart A Kinner

Journal

Journal ID (nlm-journal-id): 101699003

Journal ID (nlm-ta): Lancet Public Health

Journal ID (iso-abbrev): Lancet Public Health

Title: The Lancet. Public health

ISSN (Electronic): 2468-2667

Publication date (Print): 16 January 2020

Publication date (Electronic): 16 January 2020

Publication date Nihms-submitted: 05 February 2020

Publication date PMC-release: 17 February 2020

Volume: 5

Issue: 2

Pages: e114-e126

Affiliations

Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health; Melbourne School of Psychological Sciences; The University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health; Murdoch Children’s Research Institute, Melbourne, VIC, Australia; Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK

The University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health; Murdoch Children’s Research Institute, Melbourne, VIC, Australia; Department of Sociological Studies, University of Sheffield, Sheffield, UK

Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health; Centre for International Child Health, Department of Paediatrics

National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia

Orygen Youth Health, Melbourne, VIC, Australia

Sexual Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health

Department of Paediatrics; The University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health; Murdoch Children’s Research Institute, Melbourne, VIC, Australia; Royal Children’s Hospital, Melbourne, VIC, Australia

Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK

Centre for Health Services Research, Faculty of Medicine

Orygen Youth Health, Melbourne, VIC, Australia

Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health; The University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health; Murdoch Children’s Research Institute, Melbourne, VIC, Australia; Mater Research Institute-UQ; University of Queensland, Brisbane, QLD, Australia; Griffith Criminology Institute, Griffith University, Brisbane, QLD, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

Author notes

Correspondence to: Dr Rohan Borschmann, Justice Health Unit, Centre for Health Equity, Melbourne School, of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia rohan.borschmann@ 123456unimelb.edu.au

Article

Manuscript ID: EMS85723

DOI: 10.1016/S2468-2667(19)30217-8

PMC ID: 7025881

PubMed ID: 31954434

SO-VID: 6d6f17b3-afe7-455e-a979-18b5150cb6dc

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This is an Open Access article under the CC BY-NC-ND 4.0 license http://creativecommons.org/licenses/by/4.0/.

The health of adolescents in detention: a global scoping review

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Most cited references 138

Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis

Psychiatric disorders in youth in juvenile detention.

Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in-school studies.

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