The study, conducted by Karen M. Abram, Linda A. Teplin and co-researchers from the Psycho-Legal Studies Program at the Feinberg School of Medicine at Northwestern University, also found that the most common combination was substance abuse disorders and attention deficit hyperactivity disorder (ADHD) or behavioral disorders, which affected almost a third of 1,829 teens examined. Almost half also had anxiety disorders, affective disorders or both.
More than one of ten teens had a substance abuse disorder and a major mental disorder, such as psychosis, manic episode or major depressive episode. Among 305 teens with major mental disorders in the current study, more than half of girls and almost three fourths of boys also had a substance abuse disorder.
"Treating these youth is a real challenge," Abram said.
"Their disorders may get them into trouble. But detention centers were never designed to be mental hospitals," she said.
Results of the study, conducted at the Cook County Juvenile Temporary Detention Center in Chicago, were published in the November issue of Archives of General Psychiatry. The Cook County facility was selected because it is typical of other urban detention centers nationwide.
Mental health professionals speculated for years that because of failures in the mental health system, many adolescents with serious psychiatric disorders are arrested instead of treated. An earlier study by the Psycho-Legal Studies group found that even after excluding conduct disorder (symptoms of which include delinquent behaviors), approximately 60 percent of males and 70 percent of females in juvenile detention have at least one psychiatric disorder. Substance abuse was the most frequent disorder, affecting 50 percent of the sample. These rates of disorder far exceed those of teens in the community.
Abram estimated that, nationwide, there may be as many as 47,000 detained juveniles who have two or more types of psychiatric disorder; more than 12,000 have both a major mental disorder and a substance abuse disorder.
"Comorbidity of psychiatric disorders is the rule, not the exception," Abram said.
On an average day, more than 106,000 teens are in custody in U.S. juvenile facilities, and of these, over 60 percent are racial or ethnic minorities and from low-income families. Thus, psychiatric disorders in detained adolescents are a significant health disparities issue, Abram said.
The authors suggest that mental health professionals must collaborate with the juvenile justice system to: better screen detainees for psychiatric problems; divert youths with major mental disorders who are not community threats to treatment facilities on arrest; and reduce barriers to mental health services.
Abram is assistant professor of psychiatry and behavioral sciences. Teplin is Owen L. Coon Professor of Psychiatry and Behavioral Sciences and director of the Psycholegal Studies Program. Their co-authors on the study were Gary M. McClelland, research assistant professor of psychiatry and behavioral sciences, and Mina K. Dulcan, M.D., professor of psychiatry and behavioral sciences and head of child and adolescent psychiatry, Children's Memorial Hospital.
This study was supported by grants from the National Institutes of Health, the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and prevention, the Office of Juvenile Justice and Delinquency Prevention, the Robert Wood Johnson Foundation, the William T. Grant Foundation and a consortium of other agencies.