Adolescent Psychiatry - Volume 11, Issue 4, 2021

Background: Incarcerated adolescents within the juvenile justice system are more likely to be diagnosed with poor mental health compared with their non-incarcerated peers. Conducting clinical trials on mental health interventions among an incarcerated adolescent population is challenging due to the nature of detention facilities. Objectives: This systematic review examines available literature on Randomized Clinical Trials (RCT) done to assess mental health interventions among incarcerated adolescents globally and to determine the type of intervention that would best work in this setting. In this study, a systematic review was conducted to search, identify, and recommend effective interventions best suited to preserve and improve the mental wellbeing of incarcerated adolescents within the detention institution setting. Methods: The search was performed in Medline via Ovid, Cochrane Library, Scopus, and Web of Science databases to retrieve related publications released between 1970 and March 2021. The principal inclusion criteria were RCT articles issued in English that reported any mental health interventions performed in juvenile detention centers involving delinquent adolescents aged 10 to 19 years old. Results: The search discovered 10 related articles that fulfilled the required inclusion criteria. In total, there were seven different types of mental health interventions used in all the studies. The three major themes identified among the selected studies are the interventions for coping strategies, risky behavior, and attention disorder among incarcerated adolescents. The efficacy of the interventions was dependent on the level of intelligence, duration of incarceration, risk of treatment diffusion, and depression symptoms among incarcerated adolescents. Conclusion: Cognitive behavioral therapy (CBT) intervention that is simple, brief, unique, and targets depressive symptoms, has the potential to be most efficacious in improving mental health among incarcerated adolescents.

Background: Mental disorders affect 20% of children and adolescents globally and are among the most chronic and costly problems affecting youth. Offspring exposure to maternal disorders (depression, anxiety, and/or stress) prenatally as well as in adolescence increases the risk of psychopathology in adolescence. Objective: Exposure to maternal distress in pregnancy, as well as in adolescence, has independently been linked to psychopathology in youth. However, our understanding of the cumulative effects of exposure to maternal distress over time remains incomplete. Methods: 1964 participants enrolled in the 2014 Ontario Child Health Study (OCHS) aged 12-17 years completed the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). Maternal prenatal distress was defined as mother-reported depression and/or anxiety during pregnancy requiring treatment. Maternal concurrent distress was self-reported when offspring were 12-17 years of age using the Kessler Psychological Distress Scale (K6). We examined associations between increasing levels of exposure to maternal distress (no exposure, prenatal exposure only, concurrent exposure only, both prenatal and concurrent exposure) and the risk of psychiatric disorder in 12-17-year-olds. Results: The odds of major depressive disorder (OR=1.29, 95% CI: 1.01-1.67) and ADHD (OR=1.30, 95% CI: 1.02-1.65) increased with increasing exposure to maternal distress. Associations between increasing levels of maternal distress and several psychiatric disorders were amplified in males. Conclusion: The accumulation of exposure to maternal distress over time predicts offspring psychopathology in adolescence and emphasizes the significance of the early detection of maternal distress and ongoing monitoring and intervention to reduce the burden of mental disorders in offspring.

Background: Understanding adolescents' and emerging adults' psychiatric complaints and their relations with psychiatric disorders can be challenging. Beier Sentence Completion Test (BSCT), as a projective test, can be promising in this respect. However, relations between BSCT profiles and adolescent psychopathology are not well known. Aim: This study aimed to examine and compare BSCT profiles of adolescents and emerging adults with internalizing and externalizing disorders. As well as that, the relation of BSCT profiles with depression and anxiety scores was investigated. Objective: To achieve this aim, we retrospectively collected the hospital records of 300 adolescents and emerging adults (aged. 14-21) admitted to an Adolescent Psychiatry Outpatient Unit. Methods: The psychiatric diagnosis of the patients was classified as Internalizing (n = 100) and Externalizing (n = 100) disorder groups; the control group (n = 100) consisted of adolescents and young adults without any psychiatric diagnosis. BSCT, the Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were administered on the first admission to all cases before psychiatric evaluation and treatment. BSCT total subfactor (positive, negative, neutral, and non-response) statement scores were compared between groups, and their correlations with BDI and BAI were investigated. Besides, multivariate logistic regression analyses were conducted for estimating any diagnostic group differences, as well as bivariate logistic regression analyses for estimating BDI and BAI cutoff scores with models that included BSCT total subfactor statement scores. Results: It was revealed that lower positive and non-response statements were crucial for distinguishing externalizing and internalizing disorders and that positive and negative statements were correlated with depression and anxiety scores.In the multivariate regression model, these correlations were predictive only for the relationship between internalizing disorders group and low positive statement scores, not higher negative statement scores that can be associated with lack of positive emotional processing in this group. Also, nonresponse statement scores were found to be predictive for externalizing disorder groups. Similarly, BDI cut-off scores were predicted with low positive statement scores. Conclusion: BSCT profiles can be promising for understanding adolescents and emerging adults with internalizing and externalizing disorders. Lack of positive attributions to the self and other domains of life can be important for differentiating adolescent psychopathology.

Objective: School re-entry following hospitalization for psychiatric care has been reported as difficult for many adolescent patients. Continuous quality improvement initiatives may improve programming to enhance school re-entry experiences. The purpose for this study was to explore the school re-entry perspectives of the youth discharged from a psychiatric inpatient unit after implementing programs that patients previously identified as needed. Methods: A survey was administered to the youth about one month after discharge to gather their perspective of their school re-entry, along with self-rated resilience and stress. Results: Twenty-six youth (23%) participated in the post-discharge survey who reported a mean age of 15.6 years (SD 1.0), 77% identified as female, 13 (50%) provided very positive re-entry comments, eight (31%) reported moderately positive experiences, and five (19%) reported a very poor school re-entry. Mean perceived resilience (4.01, SD 0.6) and stress (3.42, SD 0.8) scores suggest youth thought they had good resilience and moderate stress. Conclusions: Most youth reported a good school re-entry. Considerable concerns remain for the 19% who reported a poor school re-entry who may benefit from specialized outpatient or day programming post-discharge before attempting a return to school. Future directions for research are provided.