Crime & Psychiatric Disorders among Youth in the US Population: An Analysis of the National Comorbidity Survey-Adolescent Supplement

Current knowledge regarding psychiatric disorders and crime in youth is limited to juvenile justice and community samples. This study examined relationships between psychiatric disorders and self-reported crime involvement in a sample of youth representative of the US population.

The National Comorbidity Survey-Adolescent Supplement (N=10,123; ages 13–17; 2001–2004) was used to examine the relationship between lifetime DSM-IV-based diagnoses, reported crime (property, violent, other), and arrest history. Logistic regression compared the odds of reported crime involvement with specific psychiatric disorders to those without any diagnoses, and examined the odds of crime by psychiatric comorbidity.

Prevalence of crime was 18.4%. Youth with lifetime psychiatric disorders, compared to no disorders, had significantly greater odds of crime, including violent crime. For violent crime resulting in arrest, conduct disorder, alcohol use disorders, and drug use disorders had the greatest odds with similar findings for violent crime with no arrest. Psychiatric comorbidity increased the odds of crime. Youth with 3 or more diagnoses (16.0% of population) accounted for 54.1% of those reporting arrest for violent crime. Youth with at least 1 diagnosis committed 85.8% of crime, which was reduced to 67.9% by removing those with CD. Importantly, 88.2% of youth with mental illness report never committing any crime.

Our findings highlight the importance of improving access to mental health services for youthful offenders in community settings given the substantial associations found between mental illness and crime in this nationally representative epidemiological sample.

Below:  Percentages of crime accounted for by those with varying numbers of psychiatric diagnoses, relative to population prevalence. Note: Estimates were calculated using logistic regression, accounting for the survey design. Results showed that despite making up a smaller portion of the total population, adolescents with substantial psychiatric comorbidity accounted for a much larger portion of reported crime. For example, those with no psychiatric diagnoses made up over 50% of the population, and accounted for 15.8% of those never arrested who committed violent crime, whereas those with 3 or more diagnoses made up only 16.0% of the population, and accounted for 48.4% of those never arrested who committed violent crime.

Below:  Population attributable fraction (PAF) of those who committed any crime, by number of diagnoses. Note: results are presented both with and without those with conduct disorder (CD) included in the sample. One could expect up to 86% of crime to be reduced if there were no mental illness (68% when those with CD were eliminated from the sample). PAF calculated using the following formula: PAF = Pe(RRe – 1)/[1 + Pe(RRe – 1)], where Pe is the prevalence of the exposure group and RRe is the relative risk associated with the exposure group. To obtain RRe, odds ratios were calculated using logistic regression, accounting for the survey design and adjusting for income, age, gender, and race/ethnicity. These odds ratios (ORe) were then converted to RRe using the following formula: RRe = ORe/[(l — P0) + (P0 * ORe)], where P0 is the prevalence of the outcome in the non-exposed group (0 diagnoses).

Table 1

Frequencies for Specific Disorders, Psychiatric Comorbidity Subgroups, and Crime Outcomes (N = 10,123).

	Total sample (N = 10,123)
	n	%
Attention/Disruptive
Behavior/Impulse Control
Disorders
ADHD	432	4.15
CD	586	5.44
Without alcohol or Drug abuse	278	2.65
With alcohol or drug Abuse	308	2.79
IED	1,389	14.09
ODD	1,047	10.14
Affective Disorders
Bipolar (I or II)	231	2.27
Dysthymia	335	0.34
MDD	1,123	10.82
Anxiety Disorders
Agoraphobia	293	2.66
GAD	298	3.19
Panic Disorder	238	2.35
PTSD	388	4.01
SAD	772	7.63
Social Phobia	1,434	14.46
Eating Disorders
Any Binge Disorder	532	4.95
SUDsa
Alcohol Use Disorders	678	6.43
Drug Use Disorders	880	8.93
Nicotine Dependence	713	7.04
Number of diagnoses
0	5,402	52.6
1	2,009	20.6
2	1,110	10.9
3+	1,627	15.96
Crime
Arrested
Property/theft/burglary	281	2.89
Violent	175	1.74
Other	420	4.03
Never Arrestedb
Property/theft/burglary	621	6.55
Violent	185	1.71
Other	671	7.29

Note: Percentages accounted for the survey design. The listed diagnoses are lifetime prevalence. ADHD = attention-deficit/hyperactivity disorder; CD = conduct disorder; GAD = Generalized anxiety disorder; IED = intermittent explosive disorder; MDD = major depressive disorder; ODD = oppositional defiant disorder; PTSD = posttraumatic stress disorder, SAD = separation anxiety disorder; SUDs = substance use disorders.

aAlcohol Use Disorders (Abuse+Dependence); Drug Use Disorders (Abuse+Dependence-note the Composite International Diagnostic Interview [CIDI] skip patterns do not assess dependence in the absence of abuse); Nicotine Dependence (without alcohol or drug use disorder).

bn=9,397

Full article at: http://goo.gl/SywIoY

By: Kendell L. Coker, PhD, JD, Philip H. Smith, PhD, Alexander Westphal, MD, PhD, Howard V. Zonana, MD, and Sherry A. McKee, PhD

Drs. Coker, Smith, Westphal, Zonana, and McKee are with Yale University School of Medicine, New Haven, CT. Dr. Smith is also with the School of Public Health at Yale University School of Medicine. Dr. Westphal is also with the Yale Child Study Center

  

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