Gary M. McClelland

HIV and AIDS Risk Behaviors in Juvenile Detainees: Implications for Public Health Policy

HIV and AIDS are increasingly diseases of minorities and the disadvantaged.1,2 These same groups are disproportinately involved in the justice system.3 Detained youths may be at particular risk. Sexually transmitted diseases, related to HIV and AIDS,4-6 are prevalent among detained youths. Moreover, although HIV seropositivity is infrequent among detained youths,4 studies of adult detainees suggest that detained youths are at great risk for developing HIV as they age.

Detecting Mental Disorder in Juvenile Detainees: Who Receives Services

OBJECTIVES We determined whether or not juvenile detainees with major mental disorders received treatment, and the variables that predicted who received services. METHODS Our sample was 1829 randomly selected juvenile detainees taking part in the Northwestern Juvenile Project. To determine need for mental health services, independent interviewers administered the Diagnostic Interview Schedule for Children and rated functional impairment using the Child Global Assessment Scale. Records on service provision were obtained from the juvenile justice and public health systems. RESULTS Among detainees who had major mental disorders and associated functional impairments, 15.4% received treatment in the detention center and 8.1% received treatment in the community by the time of case disposition or 6 months, whichever came first. Significantly more girls than boys were detected and treated. Receiving treatment was predicted by clinical variables (having a major mental disorder or reported treatment history or suicidal behavior) and demographic variables. CONCLUSIONS The challenge to public health is to provide accessible, innovative, and effective treatments to juvenile detainees, a population that is often beyond the reach of traditional services.

Mentally disordered women in jail: Who receives services?

OBJECTIVES Many jail inmates have severe psychiatric disorders (e.g., schizophrenia, major affective disorders). The courts have mandated that detainees have a constitutional right to treatment. We investigated what proportion of female jail detainees needed mental health services, what proportion received services, and what variables predicted who received services. METHODS Trained interviewers administered a psychiatric evaluation (the NIMH Diagnostic Interview Schedule) to 1272 randomly selected female jail detainees during jail intake in a large Midwestern city. Project staff then documented whether women subsequently received services, using records and case files. RESULTS Of the women who needed services, 23.5% received them while they were in jail. Type of disorder, treatment history, and socio-demographic variables all affected the odds of a mentally ill womans receiving services. CONCLUSIONS Correctional health care is a growing national public health problem. The magnitude of mental health service needs far exceeds current resources.

Early Violent Death Among Delinquent Youth: A Prospective Longitudinal Study

Objective. Youth processed in the juvenile justice system are at great risk for early violent death. Groups at greatest risk, ie, racial/ethnic minorities, male youth, and urban youth, are overrepresented in the juvenile justice system. We compared mortality rates for delinquent youth with those for the general population, controlling for differences in gender, race/ethnicity, and age. Methods. This prospective longitudinal study examined mortality rates among 1829 youth (1172 male and 657 female) enrolled in the Northwestern Juvenile Project, a study of health needs and outcomes of delinquent youth. Participants, 10 to 18 years of age, were sampled randomly from intake at the Cook County Juvenile Temporary Detention Center in Chicago, Illinois, between 1995 and 1998. The sample was stratified according to gender, race/ethnicity (African American, non-Hispanic white, Hispanic, or other), age (10–13 or ≥14 years), and legal status (processed as a juvenile or as an adult), to obtain enough participants for examination of key subgroups. The sample included 1005 African American (54.9%), 296 non-Hispanic white (16.2%), 524 Hispanic (28.17%), and 4 other-race/ethnicity (0.2%) subjects. The mean age at enrollment was 14.9 years (median age: 15 years). The refusal rate was 4.2%. As of March 31, 2004, we had monitored participants for 0.5 to 8.4 years (mean: 7.1 years; median: 7.2 years; interquartile range: 6.5–7.8 years); the aggregate exposure for all participants was 12944 person-years. Data on deaths and causes of death were obtained from family reports or records and were then verified by the local medical examiner or the National Death Index. For comparisons of mortality rates for delinquents and the general population, all data were weighted according to the racial/ethnic, gender, and age characteristics of the detention center; these weighted standardized populations were used to calculate reported percentages and mortality ratios. We calculated mortality ratios by comparing our sample’s mortality rates with those for the general population of Cook County, controlling for differences in gender, race/ethnicity, and age. Results. Sixty-five youth died during the follow-up period. All deaths were from external causes. As determined by using the weighted percentages to estimate causes of death, 95.5% of deaths were homicides or legal interventions (90.1% homicides and 5.4% legal interventions), 1.1% of all deaths were suicides, 1.3% were from motor vehicle accidents, 0.5% were from other accidents, and 1.6% were from other external causes. Among homicides, 93.0% were from gunshot wounds. The overall mortality rate was >4 times the general-population rate. The mortality rate among female youth was nearly 8 times the general-population rate. African American male youth had the highest mortality rate (887 deaths per 100000 person-years). Conclusions. Early violent death among delinquent and general-population youth affects racial/ethnic minorities disproportionately and should be addressed as are other health disparities. Future studies should identify the most promising modifiable risk factors and preventive interventions, explore the causes of death among delinquent female youth, and examine whether minority youth express suicidal intent by putting themselves at risk for homicide.

Does psychiatric disorder predict violent crime among released jail detainees? A six-year longitudinal study

The authors examined whether jail detainees with schizophrenia, major affective disorders, alcohol or drug use disorders, or psychotic symptoms (hallucinations and delusions) are arrested more often for violent crimes six years after release than detainees with no disorders. Trained interviewers assessed 728 randomly selected male jail detainees using the National Institute of Mental Health Diagnostic Interview Schedule and then obtained follow-up arrest data for six years. Neither severe mental disorder nor substance abuse or dependence predicted the probability of arrest or the number of arrests for violent crime. Persons with symptoms of both hallucinations and delusions had a slightly higher number of arrests for violent crime, but not significantly so. These findings held even after controlling for prior violence and age. The findings do not support the stereotype that mentally ill criminals invariably commit violent crimes after they are released. Future directions for research are suggested.

Psychiatric disorders of youth in detention

A comprehensive understanding of the prevalence of psychiatric disorders among juvenile detainees is an important step toward meeting their needs. Although epidemiological data are key to understanding the psychiatric disorders of juvenile detainees, few empirical studies exist. This chapter lists studies published in the United States since 1990 that examined the diagnostic characteristics of incarcerated and detained juveniles. The Northwestern Juvenile Project was designed to overcome the methodological limitations in two ways. Four directions for future research are recommended: pathways to co-morbidity, studies of females in the juvenile justice system, longitudinal studies, and studies of vulnerability to posttraumatic stress disorder (PTSD) in high-risk youth. Research findings indicate that a substantial number of youth in detention need mental health services. However, providing services within the juvenile justice system poses a number of challenges: screening for mental health needs, providing services, community linkages, and avoid retraumatizing youth.

HIV and AIDS Risk Behaviors Among Female Jail Detainees: Implications for Public Health Policy

OBJECTIVES We examined the sexual and injection drug use HIV and AIDS risk behaviors of female jail detainees. METHODS The sample (n = 948) was stratified by charge type (felony vs misdemeanor) and race/ethnicity (African American, non-Hispanic White, Hispanic, other). RESULTS Non-Hispanic White women, women arrested for less serious charges, women who had prior arrests, women arrested on drug charges, and women with severe mental disorders were at especially high risk for sexual and injection drug transmission of HIV and AIDS. CONCLUSIONS Many women at risk for HIV and AIDS--women who use drugs, women who trade sex for money or drugs, homeless women, and women with mental disorders--eventually will cycle through jail. Because most jail detainees return to their communities within days, providing HIV and AIDS education in jail must become a public health priority.

A longitudinal study of the prevalence, development, and persistence of HIV/sexually transmitted infection risk behaviors in delinquent youth: implications for health care in the community.

OBJECTIVES. Our goal was to examine the prevalence, development, and persistence of drug and sex risk behaviors that place delinquent youth at risk for HIV and other sexually transmitted infections. METHODS. At the baseline interview, HIV/sexually transmitted infection drug and sex risk behaviors were assessed in a stratified random sample of 800 juvenile detainees aged 10 to 18 years. Participants were reinterviewed approximately 3 years later. The final sample in these analyses (n = 724) included 316 females and 408 males; there were 393 African American participants, 198 Hispanic participants, 131 non-Hispanic white participants, and 2 participants who self-identified their race as “other.” RESULTS. More than 60% of youth had engaged in ≥10 risk behaviors at their baseline interview, and nearly two thirds of them persisted in ≥10 risk behaviors at follow-up. Among youth living in the community, many behaviors were more prevalent at follow-up than at baseline. Among incarcerated youth, the opposite pattern prevailed. Compared with females, males had higher prevalence rates of many HIV/sexually transmitted infection risk behaviors and were more likely to persist in some behaviors and develop new ones. Yet, injection risk behaviors were more prevalent among females than males and were also more likely to develop and persist. Overall, there were few racial and ethnic differences in patterns of HIV/sexually transmitted infection risk behaviors; most involved the initiation and persistence of substance use among non-Hispanic whites and Hispanics. CONCLUSIONS. Because detained youth have a median stay of only 2 weeks, HIV/sexually transmitted infection risk behaviors in delinquent youth are a community public health problem, not just a problem for the juvenile justice system. Improving the coordination among systems that provide HIV/sexually transmitted infection interventions to youth— primary care, education, mental health, and juvenile justice—can reduce the prevalence of risk behaviors and substantially reduce the spread of HIV/sexually transmitted infection in young people.

Posttraumatic stress disorder and psychiatric comorbidity among detained youths

OBJECTIVE This study examined the prevalence of posttraumatic stress disorder (PTSD) and comorbid psychiatric disorders among juvenile detainees. METHODS The sample consisted of a stratified random sample of 898 youths aged ten to 18 years who were arrested and detained in Chicago. RESULTS Among participants with PTSD, 93% had at least one comorbid psychiatric disorder; however, among those without PTSD, 64% had at least one comorbid psychiatric disorder. Over half (54%) of the participants with PTSD had two or more types of comorbid disorders--that is, affective, anxiety, behavioral, or substance use disorders--and 11% had all four types of comorbid disorders. Among males, having any psychiatric diagnosis significantly increased the odds of having comorbid PTSD. Among females, alcohol use disorder and both alcohol and drug use disorders significantly increased the odds of having PTSD. No significant difference in prevalence rates of PTSD was found between males and females with specific psychiatric disorders. The prevalence of any comorbid psychiatric disorder was significantly greater for males with PTSD than that for females with PTSD (OR=3.4, CI=1.1-10.6, p<.05). CONCLUSIONS Detection of comorbid PTSD among detained youths must be improved. PTSD is often missed because traumatic experiences are rarely included in standard screens or volunteered by patients. When planning treatment, clinicians must consider ramifications of comorbid PTSD.

Alcohol Intoxication and Violent Crime: Implications for Public Health Policy

Despite extensive public health campaigns, the consequences of alcohol intoxication continue to be a serious public health concern. Alcohol intoxication, for example, is a prevalent feature of crime, especially violent crime. Previous studies of alcohol intoxication and violent crime have used samples of police reports, correctional populations (arrestees, jail detainees, or convicted offenders), or community surveys. Studies using police reports and correctional populations are biased because few police citizen encounters result in police reports or arrest. Community surveys avoid these biases but rely on the subjects assessment of both the victims and the suspects intoxication. The authors took a different approach and directly observed 2,365 police citizen encounters. Observers used the Alcohol Symptom Checklist to determine the level of alcohol intoxication or impairment. The authors compared the prevalence of suspects and victims alcohol intoxication (equivalent to a blood alcohol level [BAL] of .05 or above) by type of encounter and computed odds ratios to assess the association between intoxication and type of encounter. The authors also controlled for demographic characteristics (race, gender, age, and socio-economic status) to assess the relationships among perpetration, victimization, and intoxication. Overall, suspects are far more likely than victims to be intoxicated; not surprisingly, suspects in public order/vandalism encounters are the most likely to be intoxicated. Alcohol intoxication appears to contribute substantially to violent victimization. The role of alcohol intoxication is largest among groups that, if not intoxicated, are generally less vulnerable to violence: whites, males, and persons of higher socio-economic status. The authors discuss the implications of these findings for services and public health policy. (Abstract Adapted from Source: American Journal on Addictions, 2001. Copyright