title: Screening for psychological and mental health difficulties in young people who offend: a systematic review and decision model.
abstract: BACKGROUND
  There is policy interest in the screening and treatment of mental health problems in young people who offend, but the value of such screening is not yet known.
  
  
  OBJECTIVE
  To assess the diagnostic test accuracy of screening measures for mental health problems in young people who offend; to evaluate the clinical effectiveness and cost-effectiveness of screening and treatment; to model estimates of cost; to assess the evidence base for screening against UK National Screening Committee criteria; and to identify future research priorities.
  
  
  METHODS
  In total, 25 electronic databases including MEDLINE, PsycINFO, EMBASE and The Cochrane Library were searched from inception until April 2011. Reverse citation searches of included studies were undertaken and reference list of included studies were examined.
  
  
  METHODS
  Two reviewers independently examined titles and abstracts and extracted data from included studies using a standardised form. The inclusion criteria for the review were (1) population - young offenders (aged 10-21 years); (2) intervention/instrument - screening instruments for mental health problems, implementation of a screening programme or a psychological or pharmacological intervention as part of a clinical trial; (3) comparator - for diagnostic test accuracy studies, any standardised diagnostic interview; for trials, any comparator; (4) outcomes - details of diagnostic test accuracy, mental health outcomes over the short or longer term or measurement of cost data; and (5) study design - for diagnostic test accuracy studies, any design; for screening programmes, randomised controlled trials or controlled trials; for clinical effectiveness studies, randomised controlled trials; for economic studies, economic evaluations of screening strategies or interventions.
  
  
  RESULTS
  Of 13,580 studies identified, nine, including eight independent samples, met the inclusion criteria for the diagnostic test accuracy and validity of screening measures review. Screening accuracy was typically modest. No studies examined the clinical effectiveness of screening, although 10 studies were identified that examined the clinical effectiveness of interventions for mental health problems. There were too few studies to make firm conclusions about the clinical effectiveness of treatments in this population. No studies met the inclusion criteria for the assessment of the cost-effectiveness of screening or treatment. An exemplar decision model was developed for depression, which identified a number of the likely key drivers of uncertainty, including the prevalence of unidentified mental health problems, the severity of mental health problems and their relationship to generic measures of outcome and the impact of treatment on recidivism. The information evaluated as part of the review was relevant to five of the UK National Screening Committee criteria. On the basis of the above results, none of the five criteria was met.
  
  
  CONCLUSIONS
  The conclusions of the review are based on limited evidence. Conclusions are tentative and the decision model should be treated as an exemplar.
  
  
  CONCLUSIONS
  Evidence on the clinical effectiveness and cost-effectiveness of screening for mental health problems in young people who offend is currently lacking. Future research should consider feasibility trials of clinical interventions to establish important parameters ahead of conducting definitive trials. Future diagnostic studies should compare the diagnostic test accuracy of a range of screening instruments, including those recommended for use in the UK in this population. These studies should be designed to reduce the decision uncertainty identified by the exemplar decision model.
  
  
  BACKGROUND
  This study is registered as PROSPERO CRD42011001466.
  
  
  BACKGROUND
  The National Institute for Health Research Health Technology Assessment programme.
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Richardson
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Dominic
authors.initials: D
authors.lastname: Trépel
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Perry
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Shehzad
authors.initials: S
authors.lastname: Ali
authors.affiliation: York Health Economics Consortium, York, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Duffy
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Rhian
authors.initials: R
authors.lastname: Gabe
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Gilbody
authors.affiliation: York Health Economics Consortium, York, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Glanville
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hewitt
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Manea
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Palmer
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Barry
authors.initials: B
authors.lastname: Wright
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Dean
authors.initials: D
authors.lastname: McMillan
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000175:diagnosis; D002648:Child; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D057237:Criminals / Q000523:psychology*; D003863:Depression / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000191:economics; D008603:Mental Health; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013222:State Medicine; D006113:United Kingdom; D055815:Young Adult