ADMINISTRACIÓN GUBERNAMENTAL DE INGRESOS PÚBLICOS

Besides criminal history outcomes, several important findings emerged pertaining to the mental health status of detained adolescents. First and foremost, findings showed high rates of mental health and substance-related concerns within the sample.

Approximately 68% of DAs who completed the Massachusetts Youth Screening Instrument-2nd _{Edition (MAYSI-2) screened positively on the measure, meaning they}

were experiencing significant behavioral health concerns during their detention stay that likely required additional assessment and treatment (Grisso et al., 2001; Vincent et al., 2008). Furthermore, almost 73% of participants were diagnosed with a mental disorder and/or substance-related disorder, 65.7% of DAs met criteria for at least one mental disorder, 35.6% of DAs met criteria for at least one substance-related disorder, and 39.6% of DAs were comorbid for both types of disorders. To put such rates into context, consider that the prevalence of such disorders among the general adolescent population is only about 15%-20% (Robertson et al., 2004; Hoeve et al., 2013), which is markedly lower than the rates found in the current study, as well as other research (Fazel et al., 2008; Hussey et al., 2008; Paskar, 2008; Sedlak & Bruce, 2010). Moreover, the

prevalence of substance-related disorders, mood disorders (40.1%), and conduct disorders (34.9%) were actually lower in this study than prior epidemiological studies of detained

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adolescents (Fazel et al., 2008; Shelton, 2001; Teplin et al., 2006). Overall, current findings not only highlight the substantial mental health concerns found among DAs, but also add to the growing literature indicating that the detained adolescent population is a vulnerable and high-risk population in desperate need of appropriate mental health and substance-related treatment services (as discussed in more detail below).

In addition to prominent behavioral health needs, findings also revealed interesting patterns between demographic variables and mental health variables. With regards to gender, females tended to endorse higher overall symptomology and more severe mental health concerns than males, whereas males tended to have more severe substance-related concerns than females. For example, a significantly higher proportions of females than males screened positively on the MAYSI-2 (about 81.2% versus 66.8%) and met criteria for a mental disorder (about 38.9% versus 35.8%); a higher proportion of males than females met criteria for a substance-related disorder (about 8.1% versus 4.8%). Further, being female was significantly correlated with higher MAYSI-2 scores, higher number of mental disorders, and comorbidity, while being male was significantly correlated with having a substance-related disorder and higher number of substance- related disorders. Altogether, current findings fit well with other research suggesting more significant mental health concerns in female DAs compared to male DAs

(Robertson et al., 2004; Veysey, 2003; Vincent et al., 2008). As mentioned earlier, the differential treatment of males and females within the legal system may account for such findings. Specifically, females are less likely to be arrested and detained (Bostwick, & Ashley, 2009; Office of Juvenile Justice and Delinquency Prevention, 2013), so female DAs tend to be the most problematic and deviant females involved in the juvenile justice system, who may also have the most severe mental health problems (Hussey et al., 2008; Veysey, 2003).

Of the few studies that have examined mental disorders and substance-related disorders separately (Aarons et al., 2004; Domalanta, Risser, Roberts, & Risser, 2003; Paskar, 2008), results have largely followed the pattern found in this study (i.e., higher prevalence of mental disorders in females and higher prevalence of substance-related disorders in males). However, this distinction is not widely discussed and represents an

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important finding with implications for connecting DAs to appropriate treatment services. Specifically, it may be more efficient and cost-effective for staff and providers within the juvenile justice system to refer and/or recommend female DAs for mental health

interventions and refer and/or recommend male DAs for substance-related interventions. Given the limited data currently available, however, additional research is needed to investigate the efficacy of such a system.

Interestingly, study findings revealed a pattern of divergent results for mental health concerns versus substance-related concerns for age, much like findings for gender. Analogous to findings for females versus males, younger DAs (age 11-13) tended to have more prominent mental health problems, with significantly more younger and mid-aged DAs than older DAs screening positively on the MAYSI-2 (approximately 71.8% versus 71.1% versus 66.5%) and meeting criteria for any disorder (approximately 77.6% versus 73.1% versus 68.4%). Being younger upon detention entry (like being female) was significantly associated with having any disorder, having a conduct disorder, and larger number of mental disorders. Conversely, being older upon detention entry (like being male) was associated with having a substance-related disorder and larger number of substance-related disorders.

To my knowledge, research has yet to fully examine differences in behavioral health status across age cohorts, thereby making it difficult to explain current findings. It is reasonable to suppose that DAs who are younger during their first detention stay are likely to be serious offenders who represent the most deviant youth involved in the juvenile justice system, much like detained females. These youth may also be more likely to have serious mental health concerns, particularly conduct-related issues (Kates et al., 2014; Sedlak & Bruce, 2010), thereby resulting in higher prevalence of mental disorders in younger DAs than older DAs (Aalsma et al., 2012b). The higher prevalence of substance-related disorders among older DAs than younger DAs may be explained by the onset of substance use. Typically, adolescents do not start experimenting heavily with substances until ages 14-15 years (Aarons et al., 2004; Kessler, Berglund, Demler, Jin, Merikangas, & Walters, 2005). Thus, younger DAs, who are only 11-13 years at

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detention entry, are less likely to have experimented and/or developed substance-related disorders than their older counterparts, who are 16-18 years at detention entry.

With regards to differences in mental health outcomes for race, findings clearly showed more prominent mental health concerns among White DAs than Black DAs. Specifically, a significantly higher percentage of White DAs compared to Black DAs screened positively on the MAYSI-2 (about 75.7% vs. 67.6%), met criteria for a mental disorder (about 73.9% vs. 60.8%), met criteria for a substance-related disorder (about 43.5% versus 30.8%), and met criteria for comorbidity (about 37.5% vs. 23.4%). Being White was also significantly correlated with higher MAYSI-2 scores, larger number of mental disorders, and larger number of substance-related disorders. In general, findings are consistent with the literature, in which White DAs tend to have more severe

symptomology than Black DAs and are more likely to meet criteria for a mental disorder, as well as multiple disorders (Soenksen et al., 2015; Teplin et al., 2012; Vincent et al., 2008). However, findings from a large meta-analysis based on approximately 70,000 youth from 283 juvenile justice facilities indicated that mental health concerns among DAs may not actually differ by race (Vincent et al., 2008); rather, racial differences may be due to White DAs being more likely than minority DAs to report their symptoms and/or providers being biased against minority DAs, resulting in higher likelihood of White DAs receiving psychiatric diagnoses. Based on findings from their meta-analysis, Vincent and colleagues (2008) noted, “One cannot conclude that there are consistent, cross-site racial differences in the presence of symptoms among youths in the juvenile justice system (pp. 289).” Inconsistencies and discrepancies across racial groups may therefore reflect differences in the behaviors of DAs and/or providers, rather than true differences in mental health concerns and treatment needs.