The associations of cumulative adverse childhood experiences and irritability with mental disorders in detained male adolescent offenders.
BACKGROUND
Adverse childhood experiences (ACEs) and psychiatric disorders are common in juvenile detainees. Emotional dysregulation resulting from cumulated ACEs may be characterized by symptoms of irritability. The present study examined whether the accumulation of ACEs, irritability, or both predicted mental disorders in incarcerated adolescents with and without controlling for one another and for socio-demographic factors.


METHODS
One hundred thirty male detained juvenile offenders (aged 13.8-19.5 years) were assessed by structured clinical interviews and a self-reporting scale for irritability. Univariate and multivariate regression models were used to examine the shared and distinct associations of ACEs and irritability with psychiatric diagnoses.


RESULTS
A total of 75 % of the participants reported more than one ACE. The ACE total score was positively related to self-reported irritability. The ACE total score predicted depressive disorders, suicidality, post-traumatic stress disorder (PTSD), and anxiety disorders. Irritability was positively related to depressive disorders, suicidality, disruptive behavior disorder (DBD), substance use disorder (SUD), and attention deficit hyperactivity disorder (ADHD). These associations remained significant in multivariate models.


CONCLUSIONS
This study provides evidence for the predictive impact of self-reported ACEs and irritability with regard to adolescent psychiatric disorders in young male inmates. Both variables differed in their predictive power for PTSD, internalizing, and externalizing disorders indicating the need for specific therapeutic interventions. Taking a close look at their trauma history seems to be of special importance for juveniles suffering from PTSD and anxiety disorders. For delinquent adolescents with DBD, ADHD and SUD, the training of emotion regulation techniques appears most promising. Approaches focusing on both, ACEs and emotion-focused contents may be implemented in the treatment of depressive disorders and suicidality.
Department of Child and Adolescent Psychosomatic Medicine and Psychotherapy, Clinic Fontane, Mittenwalde, Germany.|Department of Psychosomatics and Psychiatry, Child Protection Team, University Children's Hospital Zurich, Zurich, Switzerland.
Hannes
H
Bielas
Department of Forensic Psychiatry, Centre for Child and Youth Forensic Service, University Hospital of Psychiatry, Neptunstrasse 60, Zurich, 8032 Switzerland.
Steffen
S
Barra
University Clinics for Child and Adolescent Psychiatry, Paracelsus Medical University Salzburg, Salzburg, Austria.
Christine
C
Skrivanek
Department of Forensic Psychiatry, Centre for Child and Youth Forensic Service, University Hospital of Psychiatry, Neptunstrasse 60, Zurich, 8032 Switzerland.|Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, Zurich, Switzerland.|Division of Clinical Psychology with Children/Adolescents & Families/Couples, Department of Psychology, University of Zurich, Zurich, Switzerland.
Marcel
M
Aebi
Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, Zurich, Switzerland.|Child and Adolescent Clinical Psychology, Institute of Psychology, University of Basel, Basel, Switzerland.|Child and Adolescent Mental Health Centre, Capital Region Psychiatry, Copenhagen, Denmark.
Hans-Christoph
HC
Steinhausen
Department of Forensic Psychiatry, Centre for Child and Youth Forensic Service, University Hospital of Psychiatry, Neptunstrasse 60, Zurich, 8032 Switzerland.
Cornelia
C
Bessler
University Clinics for Child and Adolescent Psychiatry, Paracelsus Medical University Salzburg, Salzburg, Austria.
Belinda
B
Plattner
Childhood adversities; Delinquent youth; Emotion dysregulation; Juvenile offenders; Psychopathology
Biol Psychiatry. 2001 Jun 15;49(12):1023-39
11430844
Circulation. 2004 Sep 28;110(13):1761-6
15381652
J Clin Psychiatry. 2006 May;67(5):808-20
16841631
Child Maltreat. 2007 Aug;12(3):233-45
17631623
Child Maltreat. 2007 Aug;12(3):246-58
17631624
Dev Psychopathol. 2008 Spring;20(2):673-716
18423100
Psychiatr Clin North Am. 2008 Jun;31(2):223-35
18439446
Pediatrics. 2010 Apr;125(4):e778-86
20231180
J Clin Psychiatry. 2010 Mar;71(3):313-26
20331933
Can J Psychiatry. 2010 Apr;55(4):255-63
20416149
Psychiatry Res. 2011 Jan 30;185(1-2):193-9
20627325
Am J Psychiatry. 2011 Feb;168(2):129-42
21123313
Z Kinder Jugendpsychiatr Psychother. 2011 Jul;39(4):231-40; quiz 241-2
21667448
BMC Psychiatry. 2011 Jul 07;11:109
21736727
J Clin Child Adolesc Psychol. 2011;40(5):765-71
21916694
Am J Psychiatry. 2012 Jan;169(1):47-54
22193524
Psychiatry Res. 2012 Jul 30;198(2):285-90
22445705
Child Abuse Negl. 2013 Oct;37(10):788-800
23428165
Eur J Psychotraumatol. 2013 Jul 16;4:null
23869252
Vict Offender. 2013;8(4):null
24273468
Personal Ment Health. 2014 Feb;8(1):42-51
24532554
Compr Psychiatry. 2014 May;55(4):818-25
24636190
Z Kinder Jugendpsychiatr Psychother. 2014 Sep;42(5):349-59
25163997
Am J Psychiatry. 2014 Sep;171(9):918-24
25178749
J Abnorm Child Psychol. 2015 Jul;43(5):999-1009
25418616
JAMA Psychiatry. 2015 Jan;72(1):84-93
25426584
J Epidemiol Community Health. 2015 Apr;69(4):354-60
25538256
Child Abuse Negl. 2015 Aug;46:163-73
25703485
Psychosom Med. 2015 Apr;77(3):246-55
25849128
Child Abuse Negl. 2015 Sep;47:94-101
25890666
Front Behav Neurosci. 2015 Apr 08;9:79
25904853
J Child Psychol Psychiatry. 2015 Sep;56(9):949-57
25968589
Arch Sex Behav. 2015 Nov;44(8):2189-99
25981223
Arch Suicide Res. 2016;20(2):280-9
26192804
J Clin Child Adolesc Psychol. 2016;45(3):361-82
26849071
Z Kinder Jugendpsychiatr Psychother. 2016 Jan;44(1):65-74
26864228
Cognit Ther Res. 2016 Jun;40(3):394-415
27695145
Br Med Bull. 1997 Jan;53(1):156-69
9158291
Harv Rev Psychiatry. 1997 Jan-Feb;4(5):231-44
9385000
Am J Prev Med. 1998 May;14(4):245-58
9635069