Effects of Institutional Confinement for Delinquency on Levels of Depression and Anxiety Among Male Adolescents

• Author: Rolf Loeber, Eun Young Mun,Paul Hirschfield, Jing Shi,Helene R. White
• DOI: 10.1177/1541204009358657
• Published date: 01 October 2010
• Date: 01 October 2010
• Subject Matter: Articles

Youth Violence and Juvenile Justice
8(4) 295-313
Effects of Institutional
ª The Author(s) 2010
Reprints and permission:
Confinement for Delinquency on sagepub.com/journalsPermissions.nav
DOI: 10.1177/1541204009358657
http://yvjj.sagepub.com
Levels of Depression and Anxiety
Among Male Adolescents
Helene R. White,1 Jing Shi,2 Paul Hirschfield,3 Eun Young Mun1 and
Rolf Loeber4
Abstract
Youths within the juvenile justice system report higher rates of mental illnesses than their peers.
This study tested whether institutional confinement increases levels of depression and anxiety
among male adolescents. The authors examined heterogeneous trajectories of depression and
anxiety from ages 11 to 14 years for 510 male adolescents. Youths who were first placed in
custody at age 15 (treatment group) were matched with control boys (no official arrest or
reported confinement during adolescence) within each trajectory group using a propensity score
(PS) matching procedure. Matches were found for 37 pairs for depression and 34 pairs for
anxiety. There were no significant differences between the confined and control groups in levels
of depression or anxiety at age 16. More research is needed to identify aspects of the juvenile
justice system, which may positively or negatively affect youth’s mental health status.
Keywords
juvenile justice, mental health, confinement, adolescents, residential placement
Research indicates that there are high rates of mental disorders among youths involved with the juve-
nile justice system (Domalanta, Risser, Roberts, & Risser, 2003; Teplin, Abram, McClelland,
Dulcan, & Mericle, 2002; Wasserman, Ko, & McReynolds, 2004). Across studies of detained and
incarcerated adolescents, rates of internalizing disorders, such as depression and anxiety, range from
11% to 33% (Vermeiren, 2003). Although mental illnesses are clearly more prevalent among ado-
lescents confined in juvenile justice institutions than among their peers in the community (Copeland,
Miller-Johnson, Keeler, Angold, & Costello, 2007; Grisso, 2008), the reasons for these elevated
rates are not well understood. At least three explanations seem plausible: (a) mental health problems
1 Rutgers University Center of Alcohol Studies, Piscataway, NJ, USA
2 Rutgers University Center for Behavioral Health Services & Criminal Justice Research, New Brunswick, NJ, USA
3 Rutgers University Sociology Department, Piscataway, NJ, USA
4 University of Pittsburgh Western Psychiatric Institute and Clinic, PA, USA
Corresponding Author:
Helene R. White, Rutgers University Center of Alcohol Studies, 607 Allison Road, Piscataway, NJ 08854, USA.
Email: hewhite@rci.rutgers.edu
295

---

296
Youth Violence and Juvenile Justice 8(4)
directly increase the risk of arrest, detention, and incarceration, (b) arrest and subsequent confine-
ment trigger or exacerbate mental health problems, and (c) the relationship is spurious and both are
associated because of common risk factors. Because most research on mental health and juvenile
justice involvement examines juveniles at only one point in time (generally during confinement),
it has not been possible to reliably untangle the temporal or causal order of the relationship between
juvenile justice system involvement and mental health problems. Using prospective longitudinal
data collected from male adolescents well before their first confinement, the current study examines
whether institutional confinement worsens mental health, while taking the two competing
interpretations into consideration.
Explaining Higher Rates of Mental Illnesses Among Youths in
Confinement
There are various factors that can contribute to both juvenile justice involvement and mental health
problems. First, being poor and living in dysfunctional neighborhood and family conditions increase
the formality and severity of juvenile justice processing, including custodial placement (Fader,
Harris, Jones, & Poulin, 2001; Rodriguez, Smith, & Zatz, 2009), as well as mental health problems
(Costello, Messer, Bird, Cohen, & Reinherz, 1998; Fergusson & Horwood, 2001). Another possible
common cause explanation is comorbidity. That is, youths with mental disorders exhibit greater pre-
valence, frequency, and/or seriousness of delinquency and substance use (Elliott, Huizinga, &
Menard, 1989; Loeber, Stouthamer-Loeber, & White, 1999; Molina & Pelham, 2003; Weinberg
& Glantz, 1999) and these behaviors are important predictors of arrest and custodial placement deci-
sions (Fader et al., 2001; Sanborn, 1996). Finally, both mental health and juvenile justice processing
may be a function of other behaviors, including interactions at school and with peers. School prob-
lems, peer conflict, and peer isolation, as stressful life conditions, may contribute to anxiety and
depression (Aseltine, Gore, & Gordon, 2000; Elgar & Arlett, 2002). At the same time, school prob-
lems and peer behaviors may influence arrest and court placement decisions (Brownfield, Sorenson,
& Thompson, 2000; Hirschfield, Maschi, White, Traub, & Loeber, 2006; Leiber & Jamieson, 1995).
Another explanation for elevated psychopathology in secure juvenile institutions is that certain
mental health disorders may elevate the likelihood and severity of formal juvenile justice processing.
There is some evidence that externalizing behavior problems independently increase the risk of
juvenile arrest (Hirschfield et al., 2006). In addition, both externalizing and internalizing behavior
problems may indirectly increase the risk of detention and out-of-home placement. Mental health
care, especially for lower income youths, has become increasingly inaccessible in both community
outpatient settings and public mental hospitals (Grisso, 2008). When mental health placements are
unavailable, juvenile court judges may order that delinquents be sent to detention or out-of-home
placements if they are deemed dangerous to themselves or others. As a result, mental illnesses can
increase the odds that delinquents (and nondelinquent foster children) are placed in a custodial
setting (U.S. Congress, 2004; U.S. General Accounting Office, 2003).
A possible weakness of the foregoing explanation is that it treats mental health problems as pre-
existing conditions that influence juvenile justice decision making. A more dynamic explanation
recognizes that some of the mental health problems manifested among juvenile inmates are situa-
tionally conditioned and, accordingly, may be responsive to the juvenile justice process itself.
Youths with mental health problems may be particularly vulnerable to stress associated with arrest
and confinement, as well as to adverse juvenile detention conditions (Schuppe, 2004), leading them
to act out in ways that make them seem ‘‘less manageable and a greater risk to themselves or others’’
(Grisso, 2008, p. 151). Noncompliant, violent, or self-injurious behavior following apprehension
may increase the likelihood of secure detention or out-of-home placement. Furthermore, conditions
of residential placement, such as isolation from families and communities, may increase symptoms
296

---

White et al.
297
of anxiety and depression (Holman & Zeidenberg, 2006). However, separation from abusive family
members and peers can be beneficial, especially in conjunction with immersion in a supportive, ther-
apeutic environment. Some facilities, however, expose children to a risk of victimization. According
to an Associated Press survey, juvenile correctional institutions in the United States generated more
than 13,000 claims of abuse between 2004 and 2007 (Mohr, 2008). Likewise, according to the U.S.
Justice Department, staff members in public and private juvenile correctional facilities were accused
of sexual abuse against inmates 2,821 times in 2004 alone (Mohr, 2008). Juveniles who experience
trauma are unlikely to receive the treatment they need, owing to the inadequacy of mental health
screening and treatment resources and methods inside facilities (Glisson, 1996; Pear, 2003;
Teplin, Abram, McClelland, Washburn, & Pikus, 2005). Furthermore, one study found that among
18 juvenile detention residents diagnosed with major depression, 7 reported an onset of symptoms
after detention (Kashani, Manning, McKnew, Cytryn, Simonds, & Wooderson, 1980). Furthermore,
five of the seven youths who were followed up after discharge reported reduced depressive
symptomatology. In summary, juvenile justice interventions may cause depression and anxiety,
or maintain or escalate preexisting disorders.
Testing Competing Explanations
The extant literature offers a very tenuous basis to evaluate these three interpretations. Studies on the
prevalence of mental disorders among institutionalized juveniles do not help discern the temporal
order and, much less, any causal relationship between mental health problems and secure confine-
ment. To truly understand the potential causal mechanisms between mental health problems and cus-
todial placement requires a community sample and a prospective longitudinal study design.
According to one recent longitudinal study of a community sample, depression and anxiety did
not appear to increase the risk of arrest (Hirschfield et al., 2006). In fact, affective (i.e., depression)
and anxiety problems reduced the risks of arrest when demographic characteristics, delinquency,
substance use, and school and peer factors were controlled. Furthermore, there is only scant evidence
that delinquents’ mental health influences juvenile justice placement decisions (Fader et al., 2001;
Glisson, 1996). If mental health...