Sex differences in youth with mental health problems in inpatient, outpatient and youth justice settings

What you need to know

Ontario researchers compared internalizing and externalizing problems as well as exposure to traumatic life events among three groups of young people: those involved with the justice system, those receiving inpatient mental health services, and those receiving outpatient mental health services. They found that those justice-involved youth had higher rates of certain types of trauma and lower scores for internalizing symptoms, but lower scores on externalizing symptoms than inpatients. Males in the justice group had more trauma than those in the outpatient group, but not the inpatient group. Females in the justice group had more trauma and higher externalizing scores than the other two groups.

 

This Research Snapshot looks at the article, "Sex differences in youth with mental health problems in inpatient, outpatient and youth justice settings” published in BMC Psychiatry in 2020. Read it below or download the PDF.

Research Snapshots are brief, clear language summaries of research articles, presented in a user-friendly format.

What is this research about? 

As many as 10% to 25% of young people have mental health problems, but the problem is greater among those who are involved with the justice system. One study estimated that almost two-thirds of young people who are in custody have a mental disorder. 

There’s evidence that young people who are in the justice system have mental health problems that are as complex as those of young people receiving inpatient care or outpatient care. 

No study has compared the needs of these two groups, so Ontario researchers undertook a study to better understand the needs of justice-involved youth.

What did the researchers do? 

four teenagers standing together, smilingOntario researchers looked at responses to semi-structured assessment interviews, conducted using the Child and Youth interRAI instruments. This tool assesses psychiatric, substance use, social, environmental, and medical issues. The two groups were compared for internalizing and externalizing problems as well as exposure to traumatic life events.

What did the researchers find? 

Participants were between 16 and 19 years old. There were 90 youth in the youth justice group, 75 in the inpatient group, and 590 in the outpatient group. 
Justice youth had higher rates of certain types of trauma. This included the following experiences:

  • physical and emotional abuse
  • death of a parent
  • custodian change
  • death in the family
  • having a parent with addiction 
  • being abandoned by a parent
  • witnessing domestic violence
  • living in a violent neighbourhood
  • being a victim of crime
  • failing or dropping out of an education program.

Males in the justice group had more trauma than those in the outpatient group, but not the inpatient group. Females in the justice group had more trauma than those in the other two groups. 

The justice group had lower internalizing symptoms scores but lower externalizing scores than inpatients. Females in the justice group had higher externalizing scores than their peers in the other two groups.

Limitations and next steps 

This study had several limitations. For example, it didn’t look at youth substance use or consider any overlap between youth in the three groups. Its cross-sectional design also makes it difficult to draw any conclusion about a causal relationship.

Also, the youth justice group assessments were part of a pilot project and these youth were not seeking mental health services. So the results might have underestimated the mental health needs of the justice group.

Finally, this study didn’t look at other factors that are known to be related to health needs and justice involvement, such as race, ethnicity, and socioeconomic status. Future research will need to address the limitations of this study.

How can you use this research? 

This study provides information that can inform the work of system planners and agency decision makers who allocate funding and develop interventions that serve the specific mental health needs of youth involved with the justice system.

 

About the researchers

Shannon L. Stewart,1 Elizabeth Thornley,1 Natalia Lapshina,1 Patricia Erickson,2 Evelyn Vingilis,3 Hayley Hamilton,4 Nathan Kolla4

  1. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario
  2. Institute for Clinical Evaluative Sciences, Toronto, Ontario
  3. Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario
  4. Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario
  5. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
  6. University Health Network, Toronto, Ontario  

Keywords  

youth justice, interRAI, mental health, traumatic life experiences, inpatients, outpatients
This Research Snapshot is based on the article, “Sex differences in youth with mental health problems in inpatient, outpatient and youth justice settings” published in BMC Psychiatry in 2020. https://doi.org/10.1186/s12888-019-2413-z This article was written by Rossana Coriandoli.