Mental disorders among adolescents in juvenile detention and correctional facilities: an updated systematic review and metaregression analysis

Objective To synthesize evidence on the prevalence of mental disorders in adolescents in juvenile detention and correctional facilities, and examine sources of heterogeneity between studies. Method We searched electronic databases and relevant reference lists to identify surveys published from 1966 to October 2019 that reported on the prevalence of mental disorders in unselected populations of detained adolescents. We extracted data on the prevalence of a range of mental disorders (psychotic illnesses, major depression, attention-deficit/hyperactivity disorder [ADHD], conduct disorder, and posttraumatic stress disorder [PTSD]) along with predetermined study characteristics from the eligible studies. We report analyses separately for male and female adolescents, and synthesize findings using random-effects models. Potential sources of heterogeneity are examined by metaregression and subgroup analyses. Results We identified 47 studies from 19 countries on 28,033 male and 4,754 female adolescents. The mean age of adolescents assessed was 16 years (range 10-19 years). In male adolescents, 2.7% (95% confidence interval [CI] 2.0%-3.4%) had a diagnosis of psychotic illness, 10.1% (8.1%-12.2%) major depression, 17.3% (13.9%-20.7%) ADHD, 61.7% (55.4%-67.9%) conduct disorder, and 8.6% (6.4%-10.7%) PTSD. In female adolescents, 2.9% (2.4%-3.5%) had a psychotic illness, 25.8% (20.3%-31.3%) major depression, 17.5% (12.1%-22.9%) ADHD, 59.0% (44.9%-73.1%) conduct disorder, and 18.2% (13.1%-23.2%) PTSD. Metaregression found higher prevalences of ADHD and conduct disorder in newer investigations. Female adolescents had higher prevalences of major depression and PTSD than male adolescents. Conclusion Consideration should be given to reviewing whether healthcare services in juvenile detention can meet these levels of psychiatric morbidity