Comparing Rates Mental Health Diagnosis in Adolescents Evaluated at a Community Clinic versus Detention-based Clinic: Is Traumatic Stress Still Most Salient?

BACKGROUND

Adolescents involved in the juvenile legal system (JLS) have higher rates of mental health treatment needs compared to their non-justice-involved peers, and they experience disproportionate rates of trauma exposure and trauma-related psychosocial concerns. Most research comparing these adolescent groups draws data from separate studies, making it more challenging to understand meaningful differences between the two groups. Research documenting making such comparisons can guide prevention and intervention strategies for communities and their juvenile detention centers. The current study involves a secondary data analysis of billing claims from an outpatient community clinic with a satellite location embedded in the local juvenile detention center.

METHOD

Descriptive statistics determined the top five primary diagnoses in the sample apart from Post Traumatic Stress Disorder (PTSD): Major Depressive Disorder, ADHD; Adjustment Disorder, Unspecified Trauma and Stressor Related Disorder (UTD), and Generalized Anxiety Disorder (GAD). Hierarchical logistic regression models were used to understand if being evaluated in a detention or community setting, sex, and age predicted the likelihood of having one of these top primary diagnoses.

RESULTS

Participants ( = 981) were adolescents ages 12-20 (M = 15.93 years, SD = 1.924, 60.6% Male) seen for psychiatric evaluation in a community mental health agency and a juvenile detention facility. Among detained adolescents (=635), 141 were diagnosed with PTSD (22.2%), compared to 36 in the community clinic (10.4%). The odds of an adolescent in detention receiving a PTSD diagnosis were 2.5 times higher compared to adolescents evaluated in the community (<0.001, ExpB 2.54). There was a decreased likelihood for adolescents to receive a GAD or UTD diagnosis while in detention.

DISCUSSION

In this sample, adolescents evaluated in detention had significantly higher odds of being diagnosed with PTSD and a lower likelihood of receiving GAD or UTD that was not PTSD. This finding supports previous literature that adolescents in detention have higher rates of PTSD than their peers in the community. It is crucial to implement evidence-based trauma treatment in detention settings, and research should continue to examine the feasibility, acceptability, and effectiveness of these interventions.