title: A 3-year follow-up study of Swedish youths committed to juvenile institutions: Frequent occurrence of criminality and health care use regardless of drug abuse.
abstract: This 3-year follow-up study compares background variables, extent of criminality and criminal recidivism in the form of all court convictions, the use of inpatient care, and number of early deaths in Swedish institutionalized adolescents (N=100) with comorbid substance use disorders (SUD) and Attention-Deficit/Hyperactivity Disorder (ADHD) (n=25) versus those with SUD but no ADHD (n=30), and those without SUD (n=45). In addition it aims to identify whether potential risk factors related to these groups are associated with persistence in violent criminality. Results showed almost no significant differences between the three diagnostic groups, but the SUD plus ADHD group displayed a somewhat more negative outcome with regard to criminality, and the non-SUD group stood out with very few drug related treatment episodes. However, the rate of criminal recidivism was strikingly high in all three groups, and the use of inpatient care as well as the number of untimely deaths recorded in the study population was dramatically increased compared to a age matched general population group. Finally, age at first conviction emerged as the only significant predictor of persistence in violent criminality with an AUC of .69 (CI (95%) .54-.84, p=.02). Regardless of whether SUD, with or without ADHD, is at hand or not, institutionalized adolescents describe a negative course with extensive criminality and frequent episodes of inpatient treatment, and thus requires a more effective treatment than present youth institutions seem to offer today. However, the few differences found between the three groups, do give some support that those with comorbid SUD and ADHD have the worst prognosis with regard to criminality, health, and untimely death, and as such are in need of even more extensive treatment interventions.
authors.affiliation: National Board of Forensic Medicine, Department of Forensic Psychiatry, Gothenburg, Sweden; Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden. Electronic address: ola.stahlberg@rmv.se.
authors.forename: Ola
authors.initials: O
authors.lastname: Ståhlberg
authors.affiliation: Swedish Prison and Probation Services, Gothenburg, Sweden. Electronic address: sofia.boman@kriminalvarden.se.
authors.forename: Sofia
authors.initials: S
authors.lastname: Boman
authors.affiliation: Child and Adolescent Psychiatry, Stenungsund/Tjorn, Kungalvs Hospital, Sweden. Electronic address: christina.robertsson@vgregion.se.
authors.forename: Christina
authors.initials: C
authors.lastname: Robertsson
authors.affiliation: Department of Health Sciences, University West, Trollhättan, Sweden. Electronic address: nora.kerekes@hv.gu.se.
authors.forename: Nóra
authors.initials: N
authors.lastname: Kerekes
authors.affiliation: Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden; Forensic psychiatry, Institute of Neuroscience and Physiology, University of Gothenburg, Ragarden, House 1, SU - East Hospital, SE-416 85 Gothenburg, Sweden. Electronic address: henrik.anckarsater@neuro.gu.se.
authors.forename: Henrik
authors.initials: H
authors.lastname: Anckarsäter
authors.affiliation: Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden; Forensic psychiatry, Institute of Neuroscience and Physiology, University of Gothenburg, Ragarden, House 1, SU - East Hospital, SE-416 85 Gothenburg, Sweden. Electronic address: thomas.nilsson@neuro.gu.se.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nilsson
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003415:Crime / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006296:Health Services / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D006801:Humans; D007604:Juvenile Delinquency / Q000331:legislation & jurisprudence* / Q000523:psychology / Q000706:statistics & numerical data*; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D012008:Recurrence; D012114:Residential Treatment / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D013548:Sweden; D014754:Violence / Q000331:legislation & jurisprudence / Q000517:prevention & control / Q000523:psychology; D055815:Young Adult
keywords: ADHD; Criminal recidivism; Follow-up; Inpatient care; Institutionalized adolescents; Substance use