4. RESULTADOS
4.2. Resultados informantes clave, estudiantes desertores del programa
Please refer to Table 7 for all meta-analysis results. The core paper
presents summary forest plots rather than individual results for each mental disorder. Individual forest plots are available on the Appendices.
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Table 5. Pooled prevalence of mental health problems displaying chi-square and I2 heterogeneity measures
Diagnosis Male prevalence with 95% CIs χ2 value for males I2value for males Female prevalence with 95% CIs χ2 value for females I2values for females Overall prevalence Depression 17% (12%-21%) 706.29 97.17% 29% (19%-39%) 471.51 97.45% 21% (17%- 24%) Dysthymia 5% (2%-8%) 142.61 95% 22% (14%-31%) 33.4 88% 11% (7%- 15%) Manic Episodes 3% (1%-5%) 68.34 88.29% 5% (1%-8%) 22.10 81.90% 3% (2%-5%) Self-harm 11% (7%-15) 18.38 83.68% 18% (5%-32%) 30.58 90.19% 13% (9%- 18%) Suicidal attempts 16% (12%-19%) 86.06 90.70% 27% (20%-34%) 37.33 81.25% 20% (16- 25%) Psychotic illness 6% (4%-8%) 153.81 92.20% 7% (3%-11%) 45.19 84.51% 6% (4%-7%) PTSD 9% (6%-12%) 301.84 91.85% 27% (18%-35%) 110.49 94.70% 14% (11%- 17%) GAD 6% (4%-8%) 50.92 82.33% 9% (5%-13%) 60.02 86.67% 7% (5%-9%) SAD 9% (6%-12%) 75.39 89.39% 26% (11%-40%) 195.56 97.95% 14% (10%- 18%) OCD 5% (3%-7%) 143.24 92.32% 7% (4%-10%) 26.46 65.99% 6% (4%-7%) Phobia 4% (3%-6%) 9.58 16.50% 10% (4%-16%) 19.15 73.89% 5% (4%-7%)
131 Panic disorder 3% (2%-5%) 70.57 85.83% 7% (3%-10%) 30.27 80.18% 4% (2%-5%) Conduct disorder 68% (56%-79%) 2363.17 99.15% 64% (45%-83%) 1282.65 99.06% 66% (56%- 76%) ODD 26% (20%-32%) 335.21 95.82% 28% (21%-35%) 117.65 91.50% 27% (22%- 31%) ADHD 19% (14%-24%) 334.79 94.92% 27% (16%-37%) 181.71 95.05% 22% (17%- 26%) BPD 15% (10%-21%) 34.42 85.47% 42% (35%-50%) 34.42 97.09% 21% (13%- 28%) ASPD 81% (69%-91%) 55.49 94.59% 32% (1%-94%) 216.95 99.08% 62% (39%- 82%) NPD 7% (6%-8%) 1.93 0.00% 8% (4%-14%) . 0.00% 7% (6%-8%) STPD 2% (1%-3%) 0.06 0.00% 2% (1%-6%) . 0.00% 2% (1%-3%) Borderline LD 33% (18%-47% 14.13 85.84% 26% (15%-41%) . 0.00% 31% (20%- 43%) Mild LD 23% (12%-34%) 8.84 77.38% 5% (1%-17%) . 0.00% 18% (8%- 28%)
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Depression Twenty-three studies reporting on depression are displayed on a forest plot. Overall prevalence was 21% (95% CI 17%-24%); 17% (95% CI 12%-21%) male offenders and 29% (95% CI 19%-39%) female offenders. Heterogeneity was significant across studies in males χ2
value=706.29, p<0.001, I2=97.17% and in females χ2 value=471.51,
p<0.001,I2=97.45%. Gender and setting explained heterogeneity with
p=0.04 (p<0.05), β=(1.13), SE(β)=0.061 and p=0.008 (p<0.01), β=-0.20, SE(β)=0.07 respectively.
Dysthymia Nine studies reporting on dysthymia are displayed on a forest plot. Overall prevalence was 11% (95% CI 7%-15%). Females had
significantly higher prevalence rates than males; 22% (95% CI 14%-31%) females and 5% (95% CI 2%-8%) males were diagnosed with dysthymia. Heterogeneity was significant across studies in males χ2=142.61,
p<0.001,I2=95% and in females χ2=33.4,p<0.001,I2=88%. On meta-
regression for dysthymia, gender explained heterogeneity with p=0.001(p<0.01), β=0.17, SE(β)=0.04.
Manic episodes Ten studies reported on manic episodes. Overall
prevalence was 3% (95% CI 2%-5%). The results showed that 3% (95% CI 1%-5%) males and 5% (95% CI 1%-8%) females presented with manic episodes and/or mania. Heterogeneity was quite significant in males with χ2=68.34, p<0.001, I2=88.29% and in females moderate to high with
χ2=22.10, p<0.001,I2=81.90%.
Self-harm Three studies reporting on self-harming behaviours are
displayed on a forest plot. Overall prevalence in both sexes was 13%(95% CI 9%-18%). The results clearly indicate that self-harm is more dominant among female offenders with 18% (95% CI 5%-32%) prevalence than among male offenders who present with 11% (95% CI 7%-15%)
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χ2 value=18.38, p<0.001, I2=83.68% and in females χ2 value=30.58,
p<0.001, I2=90.19%.
Suicide behaviour Nine studies reported on suicidal behaviour and are displayed on a forest plot. Overall prevalence of past suicidal attempts was 20% (95% CI 16%-25%). According to the findings, 27% (95% CI 20%- 34%) female offenders and 16% (95% CI 12%-19%) male offenders had attempted suicide at least once. Heterogeneity was moderate to high in males with χ2 value=86.06, p<0.001, I2=90.70% and in females χ2
value=37.33, p<0.001, I2=81.25%. Gender explains heterogeneity on meta-
regression with p=0.03 (p<0.05), β=0.11, SE(β)=0.05.
Results from different ethnic groups could not be synthesized but they were looked at individually to infer conclusions. Abram et al., (2008) found that white groups had higher rates of suicide history compared to black and Hispanic ethnic groups while thoughts and concerns about death were more prevalent amongst African-Americans. Gallagher’s (2006) study reported that black groups seem to be at higher risk of attempting suicide given the high suicidal ideation rates. The New South Wales Young People in Custody Health Survey showed that Aboriginal groups have a slightly higher rate of past suicidal attempts than Non-aboriginal groups (Indig et al., 2009). Differences among ethnic groups could not be firmly established due to paucity of data.
Psychotic illness Fourteen studies assessed the prevalence of psychotic symptoms and/or disorder. There was no difference in prevalence rates between the two sexes, with 6% males (95% CI 4%-8%) and 7% females (95% CI 3%-11%) having psychotic illness. Heterogeneity was significant in males with χ2=153.81,p<0.001,I2=92.20% and less present in females with
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Figure 7. Pooled prevalence figure on mood and psychotic disorders among young offenders
PTSD Nineteen studies reported on PTSD prevalence rates. Overall prevalence for both sexes was 14% (95% CI 11%-17%). Females had significantly higher PTSD prevalence 27% (95% CI 18%-35%) than males 9%(95% CI 6%-12%). Heterogeneity was significant among males and females with χ2=301.84,p<0.001,I2=94.70% and χ2=110.49, p<0.001,
I2=91.85% respectively. For PTSD study size and gender explained
heterogeneity in results. On meta-regression when controlling for study size p=0.03(p<0.05), β=0.15, SE(β)=0.06 gender had a significant p-value, as p=0.002 (p<0.01),β=0.17, SE(β)=0.05.
GAD Thirteen studies reported on GAD. Overall prevalence for the two genders was 7% (95% CI 5%-9%). Females had slightly higher GAD than males with prevalence rates of 9% (95% CI 5%-13%) and 6% (95% CI 4%- 8%) respectively. Heterogeneity was moderate to high in males with
Depression Dysthymia Self-harm Past-Suicidal Attempts Manic Episodes Pyschotic Symptoms -0.01 0.09 0.19 0.29 0.39
Mood and Psychotic Disorders
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χ2=50.92,p<0.001,I2=82.33% and in females with χ2=60.02, p<0.001,
I2=86.67%. Setting explained heterogeneity with p=0.049(p<0.5), β=-0.12,
SE(β)=0.05.
SAD Eleven studies reported SAD prevalence rates. Overall prevalence for both sexes was 14% (95% CI 10%-18%). Females had substantially higher prevalence than males and, specifically 26% (95% CI 11%-40%) females and 9% (95% CI 6%-12%) males were diagnosed with SAD. Heterogeneity was significant in males with χ2=75.39 p<0.01 I2=89.39% and in females
with χ2=195.56, p<0.001, I2=97.95%. For separation anxiety disorder
gender explained heterogeneity with p=0.033(p<0.05), β=0.15, SE(β)=0.06.
OCD Thirteen studies reported on OCD. Overall prevalence was 6% (95% CI 4%-7%). The results show that 5% (95% CI 3%-7%) male offenders and 7% (95% CI 4%-10%) female offenders qualify for OCD diagnosis.
Heterogeneity was significant across studies whereas in males χ2
value=143.24, p<0.001, I2=92.32% and in females χ2 value=26.46,
p<0.001,I2=65.99%.
Phobia Ten studies reported on phobia prevalence rates. Overall
prevalence for both sexes was 5% (95% CI 4%-7%). Females had slightly higher phobia prevalence than boys with 10% (95% CI 4%-16%) and 4% (95% CI 3%-6%) respectively. Heterogeneity in males was non-significant with χ2=9.58, p=0.30, I2=16.50% and moderate in females with χ2=19.15,
p<0.001, I2=73.89%.
Panic disorder Twelve studies were identified reporting on panic disorder. Overall prevalence was 4% (95% CI 2%-5%). Prevalence rates did not differ greatly between the 2 genders; males presented with 3% (95% CI 2%-5%) prevalence and females with 7% (95% CI 3%-10%). Heterogeneity was moderate to high in males with χ2=70.57, p<0.001, I2=85.83% and in
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Figure 8. Pooled prevalence figure on anxiety disorders among young offenders
Conduct disorder Twenty-three studies reported on conduct disorder prevalence rates. Overall 66% young offenders (95% CI 56%-76%) were diagnosed with conduct disorder. Conduct disorder was present in 68% males (95% CI 56%-79%) and 64% females (95% CI 45%-83%).
Heterogeneity was significant both in males and females with χ2=2363.17,
p<0.001,I2=99.15% and χ2=1282.65,p<0.001,I2=99.06% respectively. Study
size and prevalence type explained some heterogeneity in the results. On meta-regression when controlling for study size p=0.05,β=-0.22,SE(β)=0.10 and prevalence type p<0.05,β=0.1,SE (β)=0.04.
ODD Seventeen studies reported on ODD prevalence rates. Overall ODD prevalence was 27% (95% CI 22%-31%). The results showed that 26% (95% CI 20%-32%) males and 28% (95% CI 21%-35%) females were diagnosed with ODD. Heterogeneity was significant across studies in male
PTSD Phobia GAD SAD OCD Panic Disorder 0.00 0.05 0.10 0.15 0.20 0.25 0.30 0.35 Prevalence Proportion
Anxiety Disorders males
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χ2=335.21,p<0.001,I2=95.82% and in female samples χ2=117.65,
p<0.001,I2=91.50%.
ADHD Twenty-one studies reported on ADHD. Overall prevalence for both sexes was 22% (95% CI 17%-26%). Females had higher prevalence than males; 27% (95% CI 16%-37%) females and 19% (95% CI 14%-24%) males presented with ADHD. Heterogeneity was significant for both males and females with χ2=334.79, p<0.001,I2=94.92% and χ2=181.71,
p<0.001,I2=95.05% respectively.
Figure 9. Pooled prevalence figure on disruptive behaviour disorders among young offenders
Personality disorders Overall prevalence for borderline personality disorder was 21% (95% CI 13%-28%). Heterogeneity was high with χ2
value=84.61, p<0.001, I2=91.73%. Studies reporting on APD included
1,418 participants out of those 1,137 qualified for an ASPD diagnosis. Overall prevalence for both sexes was as high as 62% (95% CI 39%-82%). Heterogeneity was significant with χ2 value=367.08 p<0.001, I2=98.37%.
Learning disabilities Studies reporting on borderline learning disabilities were identified with 145 out of 421 young offenders meeting the criteria for such a diagnosis. Overall prevalence for both sexes was 31% (95% CI
Conduct Disorder ODD ADHD 0 0.2 0.4 0.6 0.8 1 Prevalence Proportion Disruptive Behaviour Disorders
males females
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20%-43%). Heterogeneity was moderate with χ2 value=15.42, p<0.001,
I2=80.55%. Seventy-six out of 421 young offenders presented with mild
learning disabilities. Overall prevalence for males and females was 18% (95% CI 8%-28%). Heterogeneity was evident with χ2 value=19.11,
p<0.001, I2=84.30%. Only one study reported on moderate learning
disabilities whereas 291 out of 590 young offenders met the criteria for such a diagnosis. Overall prevalence for both sexes was 43% (95% CI 30%-56%). Heterogeneity was quite high with χ2 value=27.94, p<0.001,
I2=89.26%.
Figure 10. Pooled prevalence figure on personality disorders and learning disabilities among young offenders
Overall (i.e. both sexes combined), the highest pooled prevalence rates were observed for ASPD, conduct disorder, and learning disabilities. Rates were lower for depression, BPD, ADHD, PTSD and suicidal behaviour. The lowest rates were observed for mania, psychotic illness, phobias and panic disorders, and narcissistic and schizotypal personality disorders. Females
BPD ASPD NPD STPD Borderline Learning Disabilities Mild Learning Disabilities Moderate Learning Disabilities -0.2 0 0.2 0.4 0.6 0.8
Personality disorders and Learning disabilities
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had higher prevalence rates for depression, dysthymia, self-harm and suicide, PTSD, GAD, SAD, ADHD and BPD. Males had higher prevalence rates for conduct disorder and ASPD along with borderline, mild, and moderate Learning Disabilities.