title: [Psychological processes of stress management and neuroendocrine regulation in incarcerated adolescent offenders: A pilot study].
abstract: BACKGROUND
  Adolescence is a stressful period where important biological, psychological and social changes occur. Adolescents are particularly vulnerable during this developmental period and can use various strategies to deal with daily stress, such as substance use or externalizing behaviors. In previous studies, stress in adolescents with externalizing behaviors was often linked to ineffective cognitive coping strategies (i.e., constructive thinking) and overlooking the biological aspects involved in stress management such as neuroendocrine regulation. Indeed, repeated activation of the hypothalamic-pituitary-adrenal (HPA) axis in chronic stress situations may have long-term effects on subsequent cortisol regulation and lead to psychological difficulties. It was also shown that basal cortisol levels are lower in adolescents with externalizing behaviors. This study aims to assess the links between constructive thinking and neuroendocrine regulation in adolescent offenders and their association with externalizing symptoms (e.g., aggression, delinquency, psychopathic traits, substance use). Identifying particular biopsychological patterns can help to better understand stress management in youth with externalizing behaviors and to improve clinical treatments.
  
  
  METHODS
  Sixteen adolescent males aged from 12 to 18 years were recruited in an institution for juvenile offenders. Exclusion criteria were insufficient reasoning abilities assessed using the Raven Matrices Test. Regarding psychological dimensions, constructive thinking was assessed through the Constructive thinking inventory (CTI), psychopathic traits through the Youth psychopathic traits inventory (YPI), externalizing behaviors through 30 items (out of 113) and 2 subscales (aggressive behavior and delinquency problems) from the Child behavior checklist-youth self-report (CBCL), and substance use through the Dep-ado. Regarding biological dimensions, cortisol daily secretion and regulation were assessed through saliva samples that were collected during 3 consecutive days (4 samples per day: directly after awakening, at 10 a.m., at 4 a.m., and before going to bed).
  
  
  RESULTS
  Adolescent offenders presented maladaptative thinking styles and a particular neuroendocrine regulation in their daily management with stress. In particular, their level of cortisol in the morning was higher than those expected in a general population (20.34 nmol/L while the norm is around 10 nmol/L). They also showed more agressive and delinquent behaviors (CBCL) as well as more psychopathic traits (YPI) than the general population. Moreover, constructive thinking style was associated with personality and behavioral dimensions. Indeed, results indicated positive and significant correlations between categorical thinking style (CTI), psychopathic traits (YPI) (r=0.57, P=0.021) and externalizing behaviors (CBCL) (r=0.55, P=0.028). In other words, the more adolescent offenders used categorical thinking, the more they presented psychopathic traits and externalizing behaviors. With respect to the association between psychological and biological dimensions in stress management, we observed a significant and positive correlation between cortisol regulation and esoteric thinking (r=0.57, P=0.028) and a trend with superstitious thinking (r=0.47, P=0.075). The more adolescent offenders used esoteric and superstitious thinking, the poorer was their cortisol regulation. We also observed a trend between the life style scale of the YPI (i.e., impulsive, irresponsible) and the daily secretion of cortisol (r=0.51; P=0.052) as well as cortisol regulation (r=0.49, P=0.065). The more adolescent offenders presented psychopathic traits, the higher tended to be their daily secretion of cortisol and the poorer their cortisol regulation. Finally, cortisol regulation (r=0.54, P=0.038) and secretion (r=0.73, P=0.002) were significantly correlated with the DEP-Ado score. In other words, a poor cortisol regulation and a high secretion of cortisol seem to be associated with substance use.
  
  
  CONCLUSIONS
  Adolescent offenders face an important amount of daily stress and do not always have the appropriate skills to deal with it. Indeed, we know from clinical experience that they often report a sense of hopelessness toward their lack of professional perspectives as well as familial conflicts which can be important stressors in addition to the incarceration in itself. Therefore, treatment aiming to improve psychic elaboration can help these adolescents to make their thinking styles more flexible and use more appropriate ways of coping with stress instead of externalizing behaviors and substance use. Moreover, considering the complex cases of these adolescents and the many changes of caregivers and institutions where they have lived, which can be important stressors as well, professionals working with these youth should be aware of their emotional reactions toward them and try to encourage continuity of care.
authors.affiliation: Département de psychiatrie, centre hospitalier universitaire vaudois (CHUV), 34, avenue de la Gare, 1022 Chavannes-près-Renens, Suisse. Electronic address: Line.guillod@chuv.ch.
authors.forename: L
authors.initials: L
authors.lastname: Guillod
authors.affiliation: Service de psychiatrie de l'enfant et de l'adolescent (SUPEA), centre hospitalier universitaire vaudois (CHUV), Lausanne, Suisse.
authors.forename: S
authors.initials: S
authors.lastname: Habersaat
authors.affiliation: Service de psychiatrie de l'enfant et de l'adolescent (SUPEA), centre hospitalier universitaire vaudois (CHUV), Lausanne, Suisse.
authors.forename: M
authors.initials: M
authors.lastname: Suter
authors.affiliation: Service de psychiatrie de l'enfant et de l'adolescent (SUPEA), centre hospitalier universitaire vaudois (CHUV), Lausanne, Suisse.
authors.forename: T
authors.initials: T
authors.lastname: Jeanneret
authors.affiliation: Service de psychiatrie de l'enfant et de l'adolescent (SUPEA), centre hospitalier universitaire vaudois (CHUV), Lausanne, Suisse.
authors.forename: C
authors.initials: C
authors.lastname: Bertoni
authors.affiliation: Service de psychiatrie de l'enfant et de l'adolescent (SUPEA), centre hospitalier universitaire vaudois (CHUV), Lausanne, Suisse.
authors.forename: P
authors.initials: P
authors.lastname: Stéphan
authors.affiliation: Service de psychiatrie de l'enfant et de l'adolescent (SUPEA), centre hospitalier universitaire vaudois (CHUV), Lausanne, Suisse.
authors.forename: S
authors.initials: S
authors.lastname: Urben
mesh_terms: D000293:Adolescent; D000374:Aggression / Q000523:psychology; D000987:Antisocial Personality Disorder / Q000523:psychology; D002648:Child; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007604:Juvenile Delinquency / Q000523:psychology*; D008297:Male; D009483:Neuropsychological Tests; D009490:Neurosecretory Systems / Q000378:metabolism*; D010865:Pilot Projects; D011329:Prisoners / Q000523:psychology*; D011330:Prisons; D013315:Stress, Psychological / Q000378:metabolism* / Q000523:psychology*; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology
chemical_list: D006854:Hydrocortisone
keywords: Adolescents; Constructive thinking; Cortisol; Délinquants; Offenders; Pensée constructive