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Abstract This study examines differences in self-repor- ted mental health problems between detained youths from. Dutch, Moroccan, and Surinamese origin and ...
Mental health problems and recidivism among detained male adolescents from various ethnic origins Olivier F. Colins, Cyril Boonmann, Jorien Veenstra, Lieke van Domburgh, Frank Buffing, Theo A. H. Doreleijers & Robert R. J. M. Vermeiren European Child & Adolescent Psychiatry ISSN 1018-8827 Eur Child Adolesc Psychiatry DOI 10.1007/s00787-013-0384-z

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Author's personal copy Eur Child Adolesc Psychiatry DOI 10.1007/s00787-013-0384-z

ORIGINAL CONTRIBUTION

Mental health problems and recidivism among detained male adolescents from various ethnic origins Olivier F. Colins • Cyril Boonmann • Jorien Veenstra Lieke van Domburgh • Frank Buffing • Theo A. H. Doreleijers • Robert R. J. M. Vermeiren



Received: 5 July 2012 / Accepted: 23 January 2013 Ó Springer-Verlag Berlin Heidelberg 2013

Abstract This study examines differences in self-reported mental health problems between detained youths from Dutch, Moroccan, and Surinamese origin and the usefulness of mental health problems to predict violent and property recidivism in these juveniles. A sample of 296 detained boys aged between 12 and 18 years were assessed by means of the Strengths and Difficulties Questionnaire (SDQ). Official information regarding criminal history and recidivism was collected 3–6 years later. In general, Dutch youths and Surinamese youths reported more conduct problems than Moroccan youths, while Dutch youths also reported more hyperactivity than Surinamese youths. Mental health problems were not predictive of violent recidivism in any of the ethnic groups, while being related with property recidivism in Dutch and Surinamese youths. The current study showed that Moroccan youths present

O. F. Colins (&)  R. R. J. M. Vermeiren Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Center, PO Box 15, 2300, AA, Leiden, The Netherlands e-mail: [email protected] C. Boonmann  J. Veenstra  L. van Domburgh  T. A. H. Doreleijers  R. R. J. M. Vermeiren Department of Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam, The Netherlands L. van Domburgh Research and Development LSG-Rentray, Zutphen, The Netherlands F. Buffing De Waag, Centre for Forensic Psychiatry, Amsterdam, The Netherlands T. A. H. Doreleijers Faculty of Law, Leiden University, Leiden, The Netherlands

themselves on the SDQ as a less seriously disturbed group of youths than their Dutch and Surinamese counterparts. Our results also clearly showed that SDQ self-report scores are not predictive of future violent crimes in any of the three ethnic groups. Implications of the findings and limitations of the current study are discussed. Keywords Psychopathology  Antisocial  Delinquent  Risk assessment  Ethnicity

Introduction Worldwide, the overwhelming majority of youths entering juvenile justice detention centers were shown to meet criteria for one or more psychiatric disorders [1, 2]. Among these diagnoses are foremost externalizing disorders such as conduct disorders or substance use disorders, and to a lesser extent internalizing disorders such as depression or trauma-related conditions. Addressing these problems is of clinical importance, as they increase the risk of suicide attempts and/or behavioral symptoms that endanger youth and staff alike. Policy makers, researchers, and clinicians now mandate mental health screening for every youth being detained to determine the need for emergency mental health services to avert crises. In addition to its responsibility to respond to the mental health needs of youths in its custody, the juvenile justice system has the task to contribute to the safety of the community [3]. Since mental health problems are likely to increase the risk of future antisocial behavior (e.g. 4), it is important to investigate the role of mental health assessment for risk assessment purposes. However, recent studies on this topic have been conducted by means of elaborate diagnostic assessment methods, including interviews. It is thus of interest to

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investigate whether short screening list are of value as predictors of future behavior problems. The current study will therefore report on mental health screening and the relation between mental health problems and criminal recidivism in detained youths. Because previous studies have shown differences in mental health problems between ethnic groups (e.g., 5), analyses will be presented for Dutch, Moroccan, and Surinamese youths separately. Identifying youths with mental health needs Studies on mental health screening in detained youths from various ethnic origin is important for at least three reasons. First, worldwide, youths who are culturally different from the culture of the host nation are overrepresented in juvenile detention centers (e.g., 6, 7). Yet, studies on mental health problems in detained youths from various origins are relatively scarce [1, 8]. To provide appropriate mental health care to all detained youths, clinicians and researchers must be able to identify the mental health needs of these ‘minority’ youths as well. Several mental health screening instrument are available that have successfully been used in general population youths from various ethnic origins, such as the Achenbach System of Empirically Based Assessment (ASEBA) and Strengths and Difficulties Questionnaire (SDQ) forms [9]. Detained youths are, however, not a random sample of the general population due to selection factors related to their delinquent behavior and juvenile justice procedures. Results from general population studies, therefore, cannot be generalized to juvenile justice youths [10]. Second, most studies that focussed on mental health problems have been performed in the United States (e.g., 10–13). European juvenile detention centers, however, are dealing with a remarkable influx of youths from diverse countries and cultures other than those typically seen in US studies (e.g. African-American, Hispanic). For example, in the Netherlands many detained youths are from Moroccan or Surinamese origin. Thus, research is warranted to see whether the finding that detained minority youths generally report less mental health problems than their ethnic ‘majority’ counterparts [but see: 11, 10] can be replicated in other countries than the US Third, it has recently been demonstrated that detained youths in the Netherlands from Dutch origin have more mental health problems than detained youths from Moroccan origin [8]. However, this latter study used ASEBA forms to screen for mental health problems. In contrast, the Dutch Ministry of Security and Justice implemented the Strengths and Difficulties Questionnaire [SDQ; 14] as part of standardized mental health screening in all juvenile justice detention institutions in the Netherlands. Reasons the SDQ was selected relate to the low cost

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involved in using the SDQ (i.e., available for free) and the instrument’s brevity. Because detention intake is a stressful experience for many detained adolescents, using a brief instrument like the SDQ at intake may be more convenient than extended self-report questionnaires. Thus, future studies are warranted to see whether the Veen et al. [8] findings can be replicated by means of the SDQ. In addition, this latter study [8] only included detained youths from Dutch or Moroccan origin. As mentioned above, youths from Surinamese origin are also overrepresented in these institutions. Currently, however, it is unknown to what extent detained Surinamese youths differ from detained Dutch and Moroccan youths with regard to mental health problems. Identifying youths at risk for future crime Besides providing appropriate mental health care for youths under its custody, the juvenile justice system has an interest in protecting society as well as personnel against further harm caused by these youths. Thus, if mental health problems influence the risk they pose for the safety of others (e.g., violence), providing appropriate care can reduce the risk for future offending [15, 16]. Examining the relationship between mental health problems and delinquency for detained youths from various ethnic origins is important for at least two reasons. First, more than 15 years ago [17], it has been demonstrated that the relation between mental disorders and recidivism may vary by ethnic origin. Specifically, detained Caucasian recidivists (vs. Caucasian non-recidivists) were less likely to have a substance use disorder and more likely to have conduct disorder. In contrast, AfricanAmerican recidivists (vs. African-American non-recidivists) were more likely to have been diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD) and were less likely to have been diagnosed with a depressive disorder. Yet, the few studies on the relation between mental disorder and recidivism in detained youths that became available since this previous publication [17] did not explore differences between youths from various ethnic origins [4, 7, 18]. Second, the juvenile justice system must treat all detained youths equally and fairly through judicial handling. Yet, there is evidence of ethnic disparity in decisions made within the juvenile justice system (e.g., 11), with minority youths, for example, being detained more often for less serious offenses than their majority counterparts [19]. Consequently, and as cogently argued by Schwalbe and colleagues [20], the goal of promoting ethnic equity may remain unfulfilled if the predictive validity of risk assessment differs by ethnicity. So, if predictive relationships vary by ethnicity, mental health screening outcomes

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should be used with caution. If not, ethnic disparities that lead to detention intake may also affect future legal decision making (e.g., prolonged detention). Contribution and aims of the current study A difficulty in forensic assessment is the possibility to include third party informants [8, 21]. Detained youths are therefore the main source of diagnostic information because they can easily be accessed. To enable an appropriate response to the mental health needs of youths in custody, The Dutch Ministry of Justice recently implemented the SDQ-self-report form as part of standardized mental health screening in all juvenile justice detention institutions in the Netherlands. By using the SDQ, the current study will prove to be informative for policy makers and clinicians in the Netherlands because it will show the level of self-perceived mental health problems in detained youths from various ethnic origins. The current study will explore the relation between mental health problems and recidivism. Controlling for criminal history is important when predicting recidivism because criminal history has been shown to be a strong predictor of future crime in already delinquent youths [22]. So, by definition almost all detained juveniles are at risk for committing new crimes. The current study, therefore, will also examine whether mental health problems predict criminal recidivism after controlling for criminal history. In addition, comorbidity in detained male adolescents is a rule rather than an exception (e.g., 6, 23). This co-occurrence of mental health problems (e.g., comorbid conduct problems and hyperactivity) rather than a particular mental health problem on its own (e.g., hyperactivity) may increase the risk to reoffend. In line with a previous study [4], the current study will therefore also adjust for the presence of other mental health problems when examining the relation between conduct problems and violent recidivism. For the aforementioned reasons, the current study will first examine whether detained youths from Dutch, Moroccan, and Surinamese origin differ in the level of selfreported mental health problems. Based on previous findings, we expect that Surinamese and Moroccan youths will report significantly less conduct problems, hyperactivity, and emotional problems than Dutch youths. We did not have clear expectations about differences in mental health problems between Moroccan and Surinamese youths. The current study, therefore, tried to answer the following research question: to what extent will Moroccan and Surinamese youths differ in their levels of self-reported mental health problems? Second, the current study will examine to what extent mental health problems are related to future crime. Based on Wierson and colleagues [17], we

expect that the relation between mental health problems and criminal recidivism will be different in Dutch youths on the one hand and Moroccan and Surinamese youths on the other hand. We did not have clear expectations about differences in the mental health–recidivism relation between Moroccan and Surinamese youths. The current study, therefore, also tried to answer the following research question: to what extent will the relation between mental health problems and recidivism be different in Moroccan and Surinamese youths?

Method Participants Between January 2002 and December 2004, 444 boys from a juvenile detention center in the Netherlands were administered to the SDQ. These boys were detained on remand, for detention punishment reasons or pending residential treatment elsewhere. Of these 444 boys 14 were excluded from the study because they were still incarcerated at the end of the follow-up period. In addition, another 45 boys were older than 18 years of age at the time of baseline assessment. Because the SDQ has been developed for adolescents up to 16 years, we intended to respect this upper age limit as much as possible. In line with previous studies that used the SDQ self-report version in 17-year-old adolescents (e.g., 24, 25), we only included youths from 12 up to 17 years. This means that 45 boys aged 18 years or older were excluded from the current study. Finally, 89 boys were from other than Dutch, Moroccan or Surinamese origin (e.g., 17 from Turkish origin, 24 from Dutch Antillean origin). Because these numbers were too small to perform meaningful analyses, we also excluded these 89 boys from the current study, resulting in a total sample size of 296 younger than 18 years of age (mean age = 16.58; SD = 1.13; range = 12.31 to 17.99). Measures The Strengths and Difficulties Questionnaire (SDQ): the SDQ [14, 26] is a brief screening instrument for psychosocial functioning for children and adolescents available in many languages. The SDQ has a total difficulty score and five subscale scores (Emotional Symptoms, Conduct Problems, Hyperactivity, Peer Problems, Prosocial Behavior). Each subscale consists of five items with three response categories (not true = 0, somewhat true = 1, certainly true = 2). Subscale scores range from zero to ten. In the current study we only used the three subscales of the SDQ self-report form referring to mental health problems (i.e., Emotional Symptoms, Conduct Problems,

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Hyperactivity). All the juveniles were administered the Dutch version of the SDQ self-report. The internal consistency of the self-report version of the SDQ as indicated by Cronbach’s alpha in an epidemiological sample of British adolescents [27] and a community sample of Dutch adolescents [26] was 0.66 and 0.63 for emotional problems, 0.60 and 0.47 for conduct problems, and 0.67 and 0.66 for hyperactivity. In the current study, Cronbach’s alpha within each ethnic subgroup were, for emotional problems 0.64 (Dutch), 0.58 (Moroccan) and 0.69 (Surinamese); for conduct problems: 0.47 (Dutch), 0.39 (Moroccan), and 0.42 (Surinamese); and for hyperactivity: 0.77 (Dutch), 0.67 (Moroccan), and 0.57 (Surinamese). In general, the internal consistency of the three SDQ scales in youths from a juvenile detention center in the Netherlands was in line with the results reported in the Dutch community sample [26]. Criminal history and criminal recidivism information regarding criminal history and criminal recidivism was retrieved from the Judicial Documentation System (JDS) with approval from the Ministry of Security and Justice. The JDS provides data on convictions of juvenile offenders. Information on the criminal cases includes—among other things—the date the criminal case was recorded, details on the criminal act and how the judicial authorities handled the case. All criminal cases ending in full acquittal, technical decision, or dismissal by reason of unlikelihood of conviction were not taken into account in determining criminal history and recidivism. In addition, criminal cases that have not been settled yet were included because it is more likely the case will end in a valid disposal than in full acquittal [28]. Criminal history refers to the number of convictions for violent (i.e., sexual offenses, murder, manslaughter, and theft with violence), property(i.e., burglary, fire setting, theft, and vandalism), and drugrelated crimes (use, possession and dealing of drugs (alcohol not included)) before being administered to the SDQ. Criminal recidivism refers to any conviction for violent, property- , and drug-related crimes after being administered to the SDQ and up to March 11, 2008. Time at risk information about total time of incarceration during the follow-up period from the boys in this study was obtained from TULP (a justice registration system during admission). These data were collected to control for the time at risk. Time at risk was defined as the total number of days after release from the juvenile detention center minus the total number of days that participants were detained during the follow-up period after release from the juvenile detention center. Ethnic background according to the Dutch standard classification of ethnic groups (Dutch Central Bureau of Statistics), participants were categorized as ‘‘Moroccan’’ or ‘‘Surinamese’’ when the adolescents itself and/or at least

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one parent had been born in Morocco or Surinam, respectively. When both parents were of non-Dutch origin, we used mother’s country of birth to determine the child’s ethnicity. Participants were classified as Dutch when both parents and the child were born in the Netherlands. Procedure Participants were administered to the SDQ as part of a standardized screening procedure for mental health problems. In general, screening took place within the first couple of days after intake. All participants were given oral and written information about the aims and content of the screening procedure, and therefore, were aware that the SDQ would be used for clinical purposes so that clinicians could provide them matched care with respect to mental health problems. In case youths experienced difficulties with reading and understanding the questions, support from juvenile detention personnel was available. Statistical analysis First, we present descriptive statistics for sociodemographics, criminal history, criminal recidivism and mental health problems for the total sample and for ethnic subgroups. Second, because assumptions for ANOVA were violated (e.g., non-normal distribution of the residuals) differences between ethnic subgroups in mental health problems, criminal history, and recidivism were examined with the Kruskal–Wallis test (H). However, the Kruskal–Wallis test does not reveal significant differences between different pairs of subgroups. Therefore, we applied a series of Mann–Whitney tests (U) to compare each ethnic subgroup with the other two subgroups. Third, assumptions for linear regression analyses were violated (e.g., non-normal distribution of the residuals). Within each ethnic subgroup we, therefore, performed multiple univariate logistic regression analyses (method Enter) with dichotomous recidivism outcomes as dependent variable and criminal history (continuous) and mental health problems (continuous) as independent variables (from here on referred to as univariate models). Fourth, to test whether, for example, conduct problems remained related to recidivism after adjusting for criminal history, time at risk and other mental health problems, we also performed multiple multivariate logistic regression analyses (method enter) with all independent continuous variables in the same model (i.e., emotional problems, conduct problems, hyperactivity, past violent convictions, past property convictions, past substance-related convictions, and time at risk) (from here on referred to as multivariate models). For all logistic regression analyses we

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present odds ratio (OR) and 95 % confidence intervals (95 % CI). In line with Wierson and Forehand [17], we also present an indicator that shows how much variance of recidivism is explained in each univariate and multivariate model (Nagelkerke2). Statistical analyses were performed using SPSS (Statistical Package for Social Sciences, version 18). Statistical significance was set at 0.05 for all tests.

Regarding group differences for criminal history, Surinamese youths had more previous convictions for violent crimes and substance-related crimes than Dutch and Moroccan youths and fewer previous convictions for property crimes than Moroccan youths. Regarding group differences for criminal recidivism, Moroccan youths had more future convictions for property crimes than their Dutch and Surinamese counterparts and fewer future convictions for substance-related crimes than Surinamese youths (Table 1).

Results Ethnic differences in mental health needs

Descriptives total sample Table 1 shows descriptive information regarding age, number of past crimes, and number of future violent, property-, and substance-related crimes for the total sample. Both the Moroccan and the Surinamese subsample were comparable to the Dutch subsample for age and time at risk (Table 1). In addition to this information presented in Table 1, the mean follow-up period was 1,717 days (SD = 260; range: 1,191–2,240 days) and the mean time at risk (i.e., the numbers of day not in detention) 1,328 days (SD = 482; range 5–2,115). Ethnic differences in criminal history and recidivism Table 1 also shows that, with regard to criminal history, Dutch and Moroccan youths were most often convicted in the past and the future for property offenses, whereas Surinamese youths were most often convicted in the past and the future for violent offenses.

Table 2 shows that Dutch youths reported more emotional problems, conduct problems, and hyperactivity than Moroccan youths, and more emotional problems and hyperactivity than Surinamese youths. Surinamese youths reported more conduct problems and hyperactivity than Moroccan youths. Criminal history and mental health problems as predictor of violent and property recidivism Multiple logistic regression analyses with dichotomous recidivism outcomes (i.e., violent and property recidivism, respectively) as dependent variable and continuous criminal history-related, and SDQ-related independent variables were performed. Because merely eight Dutch boys (8.6 %) and nine Moroccan boys (7.9 %) were reconvicted for substance-related crimes, analyses with this type of recidivism as outcome variable were not performed.

Table 1 Mean scores and standard deviations for age, criminal history and criminal recidivism for the total sample and differences between ethnic subgroups Total (n = 296) Mean (SD) Age Time at risk

Dutch (D) (n = 93) Mean (SD)

Moroccan (M) (n = 114) Mean (SD)

Surinamese (S) (n = 89) Mean (SD)

H; p

16.58 (1.13)

16.62 (1.11)

16.62 (1.10)

16.51 (1.19)

0.40; 0.82

1,328.37 (482.99)

1,400.00 (475.39)

1,403.66 (413.27)

1,221.69 (553.92)

4.10; 0.13

U (p \ 0, 0.05)

Criminal history DM \ S

Violent

1.52 (1.46)

1.42 (1.53)

1.35 (1.30)

1.84 (1.55)

7.40; 0.02

Property

2.57 (3.08)

2.95 (3.62)

2.89 (3.01)

1.77 (2.36)

10.14; \0.01

M[S

Substance-related

0.07 (0.33)

0.05 (0.31)

0.03 (0.21)

0.16 (0.45)

11.98; \0.01

DM \ S

Violent

0.76 (1.03)

0.59 (0.85)

0.82 (1.07)

0.87 (1.13)

2.90; 0.23

Property

1.77 (3.21)

1.97 (4.36)

2.10 (2.92)

1.13 (1.78)

9.03; 0.01

D \ M, M [ S

Substance-related

0.17 (0.60)

0.11 (0.37)

0.13 (0.51)

0.30 (0.83)

6.07; \0.05

M\S

Recidivism

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Author's personal copy Eur Child Adolesc Psychiatry Table 2 Mean scores and standard deviations for strengths and difficulties questionnaire for the total sample and differences between ethnic subgroups Dutch (D) (n = 93) Mean (SD)

Moroccan (M) (n = 114) Mean (SD)

Surinamese (S) (n = 89) Mean (SD)

Emotional problems

2.01 (2.17)

2.46 (2.20)

1.65 (1.93)

2.00 (2.35)

Conduct Problems

2.41 (1.97)

3.05 (2.07)

1.83 (1.70)

2.48 (1.98)

19.14; \0.001

DS [ M

Hyperactivity

3.09 (2.63)

4.71 (2.76)

1.96 (2.09)

2.87 (2.26)

53.54; \0.001

D [ MS; M \ S

Any violent recidivism Neither in univariate nor in multivariate analyses mental health problems and criminal history were significantly related with any violent crime in Dutch, Moroccan, and Surinamese youths (Table 3). Any property recidivism Univariate analyses: in Dutch youths past convictions for property offenses and conduct problems were positively related with property recidivism. In Moroccan participants, past convictions for property crimes and emotional problems scales were positively related to property recidivism. In Surinamese youths hyperactivity was positively related to property recidivism. Multivariate analyses: in Dutch youths conduct problems and past property offending remained positively related to property recidivism. In Moroccan youths past violent convictions were negatively and past property convictions positively related to property recidivism, while mental health problems were not significantly predictive of property recidivism anymore. In Surinamese youths, emotional problems were negatively related and hyperactivity positively related to property recidivism (Table 4).

Discussion This study examined self-reported mental health problems in detained youths from Dutch, Moroccan, and Surinamese origin and the relation between these problems and recidivism. In general, Dutch youths and Surinamese youths reported more mental health problems than Moroccan youths, while Dutch youths also reported more emotional problems and hyperactivity than Surinamese youths. Mental health problems were not predictive of violent recidivism in any of the ethnic groups, but were related to property recidivism. From a mental health perspective, this study showed that by means of a short self-report questionnaire, Dutch youths reported more mental health needs than Moroccan and

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H

U (p \ 0, 0.05)

Total (n = 296) Mean (SD)

9.12; 0.01

D [ MS

Surinamese youths. This finding agrees with that of a previous study on mental health problems in detained Dutch and Moroccan adolescents [8]. Differences in judicial handling may explain differences in mental health problems between Dutch and Moroccan youths. Moroccan youths, for example, have been found to be more often detained for less serious offenses than Dutch youths [8]. Moroccan youths, therefore, may constitute a less seriously disturbed group of youths than their Dutch counterparts [19]. However, the current and the Veen et al. [8, 19] studies do not allow the firm conclusion that detained Moroccan (and Surinamese) youths really have less mental health problems than Dutch youths. It may well be that youths are simply less inclined to express their thoughts and feelings to persons they consider to be affiliated with the juvenile justice system. Also, it is possible that these youths simply do not fully comprehend the questions, that words such as ‘‘anger’’ or ‘‘fear’’ trigger different associations in young people with different cultural backgrounds, or that their feelings of anger and depression are expressed in a way (e.g., social retreat) that is not or not fully captured by the SDQ items referring to emotional problems [29, 30]. Therefore, researchers and clinicians should also rely on different sources for screening and assessment of mental health problems in detained ‘minority’ youth, such as observations by staff. This latter source of diagnostic information seems particularly interesting since juvenile detention staff have the possibility to observe these juveniles twenty-four seven in many different situations (e.g., in class, during leisure activities) and in interaction with many different persons (e.g., peers, staff, parents). On the other hand, it has recently been demonstrated that male youths from, for example, Moroccan origin were less likely than Dutch adolescents to enter mental health care in the Netherlands [31]. Also, in normal population youths, Moroccan youths had lower levels of mental health needs than their Dutch counterpart [8]. These latter findings also may suggest that detained minority youths simply have less mental health problems. Yet, this latter option does not converge with many previous studies that demonstrated that ethnic minorities with mental health

1.01 (0.26; 3.89) 0.89 (0.73; 1.08)

1.17 (0.96; 1.44)

1.04 (0.89; 1.21)

NA

Past property

Past substance-related Emotional Problems

Conduct Problems

Hyperactivity

Nagelkerke2 for multivariate models NA

0.4

3.4

0.0 2,0

0.5

2.5

Nagelkerke2

Nagelkerke2 = 11.8

1.02 (0.86; 1.22)

1.23 (0.97; 1.56)

0.98 (0.24; 4.04) 0.86 (0.69; 1.06)

0.90 (0.78; 1.05)

1.26 (0.93; 1.70)

Only one independent variable used in the analyses (e.g. Past violent)

NA

1.01 (0.85; 1.21)

0.96 (0.77; 1.19)

0.65 (0.10; 4.35) 0.94 (0.78; 1.14)

1.01 (0.89; 1.15)

1.06 (0.80; 1.42)

OR (95 % CI)

Univariate

a

NA

0.00

0.2

1.9 0.4

0.1

0.2

Nagelkerke2

Nagelkerke2 = 8.9

1.08 (0.88; 1.33)

0.90 (0.70; 1.17)

0.64 (0.10; 4.18) 0.88 (0.71; 1.10)

1.00 (0.87; 1.14)

1.03 (0.76; 1.38)

OR (95 % CI)

Multivariate

b

Moroccan (no recidivist = 48/ recidivist = 66) a

NA

1.16 (0.95; 1.40)

1.13 (0.91; 1.41)

1.27 (0.50; 3.28) 0.93 (0.77; 1.11)

0.99 (0.84; 1.19)

1.06 (0.81; 1.38)

OR (95 % CI)

Univariate

NA

3.4

2.0

0.4 1.0

0.00

0.2

Nagelkerke2

b

Nagelkerke2 = 10.9

1.25 (0.98; 1.61)

1.13 (0.86; 1.47)

1.79 (0.60; 5.32) 0.81 (0.65; 1.02)

1.01 (0.84; 1.22)

1.01 (0.76; 1.36)

OR (95 % CI)

Multivariate

Surinamese (no recidivist = 35/ recidivist = 54)

1.07 (0.92; 1.24)

NA

Hyperactivity

Nagelkerke2 for multivariate models NA

1.0

13.8

1.3

1.1

14.2

0.5

Nagelkerke2

b

a

b

Nagelkerke2 = 26.7

0.99 (0.82; 1.19)

1.38 (1.07; 1.79)**

0.91 (0.72; 1.14)

0.51 (0.07; 3.77)

1.77 (1.00; 2.49)*

0.86 (0.63; 1.16)

OR (95 % CI)

Multivariate

NA

1.12 (0.92; 1.34)

1.14 (0.90; 1.44)

1.30 (1.02; 1.66)*

0.49 (0.07; 3.35)

1.19 (1.01; 1.40)*

0.79 (0.59; 1.06)

OR (95 % CI)

Univariate

a

NA

1.5

1.5

6.1

0.7

6.0

2.9

Nagelkerke2

b

Nagelkerke2 = 19.1

1.09 (0.86; 1.37)

0.97 (0.73; 1.30)

1.32 (0.99; 1.77)

0.32 (0.04; 2.61)

1.25 (1.04; 1.52)*

0.68 (0.48; 0.95)*

OR (95 % CI)

Multivariate

Moroccan (no recidivist = 44/ recidivist = 70)

a

NA

1.31 (1.07; 1.61)***

1.08 (0.87; 1.34)

0.86 (0.71; 1.04)

0.41 (0.13; 1.34)

1.13 (0.93; 1.36)

1.06 (0.81; 1.39)

OR (95 % CI)

Univariate

NA

10.8

0.8

3.7

4.0

2.4

0.3

Nagelkerke2

b

Nagelkerke2 = 26.8

1.58 (1.18; 2.12)***

1.05 (0.79; 1.41)

0.66 (0.50; 0.89)***

0.72 (0.22; 2.40)

1.13 (0.92; 1.39)

0.96 (0.70; 1.31)

OR (95 % CI)

Multivariate

Surinamese (no recidivist = 49/ recidivist = 40)

All six independent variables (i.e. past violent, past property, past substance-related, emotional problems, conduct problems, hyperactivity) and time at risk simultaneously used in the analyses

Only one independent variable used in the analyses (e.g. Past violent)

OR odds ratio; CI Confidence Interval, NA not applicable

0.91 (0.75; 1.10)

1.40 (1.13; 1.75)***

0.51 (0.10; 2.79)

Past substance-related

Conduct Problems

1.23 (1.07; 1.42)***

Past property

Emotional Problems

0.92 (0.70; 1.21)

Past violent

OR (95 % CI)

Univariate

a

Dutch (no recidivist = 52/ recidivist = 41)

Table 4 Mental health needs as predictor of criminal reconvictions for any property crime by ethnic origin group

All six independent variables (i.e. past violent, past property, past substance-related, emotional problems, conduct problems, hyperactivity) and time at risk simultaneously used in the analyses

b

a

b

OR (95 % CI)

Multivariate

OR odds ratio, CI Confidence Interval, NA not applicable

1.20 (0.91; 1.58)

0.96 (0.86; 1.86)

Past violent

OR (95 % CI)

Univariate

a

Dutch (no recidivist = 41/recidivist = 51)

Table 3 Mental health needs as predictor of criminal reconvictions for any violent crime by ethnic origin group

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problems make little use of mental health services [32–34], for example, because they think they will be misunderstood or stigmatized or due to differences in help seeking behavior (e.g., seeking other sources of support than mental health professionals) [32, 35]. From a criminological perspective, the current study is informative for policy makers as well. First, our results clearly demonstrated that mental health screening by means of the SDQ self-report form is not predictive of future violent crimes in any of the three ethnic groups. Our second hypothesis, thus, could not be confirmed when violent recidivism was the outcome variable. While conduct problems, inattention, hyperactivity, and impulsivity in normal population studies were predictive of violent offenses [36], our study may suggest that these problems do not predict violent recidivism in already seriously delinquent adolescents. This finding agrees with previous studies in detained youths focusing on conduct disorder and ADHD [4], and suggests that clinicians should not use the SDQ for assessing the risk for future violence. Second, just like in detained African-Americans in the US [17], emotional problems were negatively related while ADHD-related problems were positively related to property recidivism among detained Surinamese youths. This relation between ADHD symptoms and property crimes has also been reported previously among detained [37] and normal population youths [36], possibly due to problems with impulsivity and the delay of gratification. In addition, and just like in detained Caucasian youths in the US [17], conduct problems were positively related with future crime in Dutch detained youths only. Overall, both the current and the Wierson and Forehand [17] study suggest that ethnic differences in the relation between mental health problems and recidivism must be considered. This is relevant because mental health problems can be considered as a dynamic risk factor that is changeable, in contrast to static risk factors (such as prior arrests). Therefore, referral to appropriate services while being detained may reduce the risk for future property offending. The current study suggests that the appropriateness of services may depend on the ethnic origin of the youth. From a psychometric perspective, the current study is also informative for researchers and clinicians interested in the reliability and validity of the SDQ across youths from different ethnic origins. The SDQ is available in many languages such as Surinamese and Arabic. Yet, to the best of our knowledge, no previous studies have been published that reported on the reliability and validity of the SDQ self-report version in Surinamese and Moroccan adolescents living in Suriname or Morocco or living abroad (e.g., in the Netherlands). With regard to the reliability of the SDQ scales, emotional problems,

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conduct problems, and hyperactivity, our results showed that the reliability of these three scales was generally as good as the reliability indices presented in the Dutch SDQ validation study [26]. With regard to the validity of the SDQ self-report version, the current study showed that these three subscales only have some predictive validity when property offenses are the recidivism outcome of interest, but no predictive validity when violent recidivism is the recidivism outcome of interest. Because the SDQ has rarely been used in detained adolescents as well as in youths from different ethnic origin, future psychometric studies in these youths on the SDQ self-report version are warranted. Such studies, for example, may wish to use Items Response Analyses (IRA) to identify whether some items in these scales are performing differently for one ethnic group than for another in assessing the trait at which all of the items in the scale are aimed. Differences based on IRA methods would allow one to infer that the item has different latent meanings for the Dutch, Moroccan, and/or Surinamese detained youths. The outcome of the IRA may subsequently be used to increase the reliability of these scales in particular groups of youths (e.g., the Hyperactivity scale in Surinamese adolescents). Unfortunately, the present study did not provide sufficient numbers of participants for IRA. A recent Norwegian study on the factor structure of the SDQ self-report version for 15- to 16-year-old adolescents from Norwegian and other ethnic minorities (e.g., Pakistani) underscored the importance of future psychometric studies on the SDQ. This Norwegian study showed that it remains unclear, for example, how the scores should be interpreted in an ethnic minority population with very different ethnic and cultural backgrounds [38]. The results of the current study must be interpreted in the light of some limitations. First, we defined criminal history and recidivism by official conviction data. By using official recidivism information instead of self-report information we might have underestimated recidivism in our sample. Second, in line with most studies on psychiatric disorders in detained youths [1] we merely relied on youth self-report of mental health problems. Although gathering diagnostic information on mental disorders from parents of detained adolescents is expensive and timeconsuming, it has been demonstrated that obtaining parental diagnostic information in delinquent adolescents appears to be important for predicting recidivism [39]. Third, our sample size was too small to examine interaction effects between mental health problems. Therefore, we were not able to test whether particular combinations of mental health problems (e.g., conduct problems comorbid with hyperactivity) were related to recidivism. Conflict of interest

None.

Author's personal copy Eur Child Adolesc Psychiatry

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