Psychiatric Disorders in Detained Male Adolescents: A Systematic Literature Review

Objective: To provide a best estimate of the prevalence of psychiatric disorders among detained male adolescents, with particular emphasis on impairment, multi-informant assessment, and race or ethnicity. Method: Computer-assisted searches were executed to identify relevant studies. Results: Fifteen studies using adolescents as informants met inclusion criteria (n = 3401), of which only 2 reported within a subsample on parent-derived diagnoses. The mean prevalence of any disorder was 69.9% (95% CI 69.5% to 70.3%); with conduct disorder occurring most frequently (46.4%, 95% CI 45.6% to 47.3%), followed by substance use disorder (45.1%, 95% CI 44.6% to 45.5%), oppositional defiant disorder (19.8%, 95% CI 19.2% to 20.3%), and attention-deficit hyperactivity disorder (13.5%, 95% CI 13.2% to 13.9%). Although lower, rates for internalizing disorders were still substantial, with any anxiety disorder found in 15.9% (95% CI 15.6% to 16.1%), major depression in 12.0% (95% CI 11.7% to 12.2%), and posttraumatic stress disorder in 9.6% (95% CI 9.2% to 10.0%). Three studies reported on psychotic disorders, finding low rates (1.35%, 95% CI 1.32% to 1.39%). Estimates of prevalence were only marginally different when impairment was not required, while consistency between adolescents and parents was poor. Findings on the relations between race or ethnicity were too scarce and inconsistent to interpret. Conclusion: Detained male adolescents bear substantial mental health needs, emphasizing the need to organize effective mental health services for this troubled group. However, our knowledge on mental disorders in detained youth should be enhanced, in particular regarding the reliability of adolescents, compared with parent report, and whether clinically relevant differences exist by race or ethnicity.