mbach et al. Child and Adolescent Psychiatry and Mental Health 2013, 7:7 http://www.capmh.com/content/7/1/7

RESEARCH Open Access

Internalizing and externalizing problems, depression, and self-esteem in non-detained male juvenile offenders Daniela Imbach1*, Marcel Aebi1, Christa Winkler Metzke1, Cornelia Bessler1 and Hans Christoph Steinhausen1,2,3

Abstract

Background: High rates of mental disorders have been found in detained juvenile offenders, whereas the role of psychopathology in non-detained offenders is less clear. Therefore, the present study compared psychopathology in male non-detained delinquent juveniles and two matched samples from the community and an adolescent psychiatric clinic.

Methods: 125 male adolescents aged 11 to 19 years (m = 16.2 years, SD = 1.5 years) from an outpatient adolescent forensic clinic were compared to a community sample from the Zurich Adolescent Psychology and Psychopathology Study (ZAPPS) and a referred sample from a psychiatric clinic matched for age and nationality. All subjects responded to questionnaires measuring internalizing and externalizing problems, depressive symptoms and self-esteem.

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Results: The sample of non-detained juvenile offenders showed similar rates of self-reported internalizing and externalizing problems when compared to the community sample, whereas the clinic sample displayed an increased rate of various disturbances. Similar results were found also for self-esteem. In agreement with these findings, non-detained juvenile offenders less frequently had a psychiatric diagnosis after full clinical assessment when compared to the clinical sample. However, a diagnosis of conduct disorders and a lower IQ range was found more frequently in non-detained juvenile offenders. Offenders with serious delinquent acts and involving weapons showed higher depression scores than the rest of the offenders.

Conclusion: In non-detained assessment situations before court examination, juvenile offenders present rather normal behaviour. Their lack of awareness of potential behavioural problems should be considered during assessment and treatment of this group of offenders.

Keywords: Juvenile offenders, Internalizing and externalizing problems, Depression, Self-esteem

Introduction There is clear evidence that incarcerated juveniles show high rates of psychiatric disorders and comorbidity [1-6]. In particular, high rates of conduct disorders, ADHD, anxiety, depression, substance abuse and PTSD were found. Even after excluding common conduct disorders, delinquent adolescents still show high rates of other mental disorders. Compared to community and clinical samples, they display higher rates of internalizing and

* Correspondence: [email protected] 1Forensic Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland Full list of author information is available at the end of the article

© 2013 Imbach et al.; licensee BioMed Central Commons Attribution License (http://creativec reproduction in any medium, provided the or

externalizing disorders [2,7,8]. However, according to Vermeiren [5], findings in incarcerated juveniles cannot be transferred to non-detained offenders. Currently, only a few studies have evaluated the frequencies of mental disorders in general in this specific group of non- detained juveniles [2,5,9]. An increased rate of conduct disorders, substance abuse and depressive symptoms were found in two of these studies [10,11]. Among various mental disorders, depression and

affective disorders play a particular role in juvenile offenders. Ritakallio et al. [9] found a robust association between self-reported delinquency and depression. The strongest associations with depression were identified

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Imbach et al. Child and Adolescent Psychiatry and Mental Health 2013, 7:7 Page 2 of 8 http://www.capmh.com/content/7/1/7

for frequent vandalism and violent behaviour. Depres- sion increased with the frequency of delinquent behav- iour in boys as well as in girls. Mood disorders were frequently seen both in incarcerated juvenile delinquents and in juveniles with mixed detention situations with prevalence rates varying between 10 to 78% [5,12]. Fur- thermore, high scores of adjustment disorders with depressed mood were also observed in outpatient samples [10] and high rates of depressive symptoms based on the Beck’s Depression Inventory [13] were reported [14,15]. In addition, Howard [16] found that juveniles with more serious offenses had higher levels of depression in self-reports. However, this relation was not replicated in the study by Alessi, McManus, Grapentine & Brickman [17]. Among various personality features, self-esteem plays a

major role due to its close association with various kinds of psychopathologies and delinquencies. There are contra- dictory findings on the association of self-esteem and de- linquency with some studies finding no relation between these two variables [8,18,19], and others reporting a nega- tive association between self-esteem and delinquency [20-23]. It has also been postulated that low self-esteem fosters delinquency and delinquency vice-versa may en- hance self-esteem [24]. Most of these studies used self- reports to identify delinquency. Furthermore, a grandiose sense of self-worth has been postulated as a feature of psychopathy in juvenile offenders and is reflected in the Hare Psychopathy Checklist: Youth Version [25]. In addition to focusing on psychopathology and per-

sonality features in both incarcerated and non-detained juvenile delinquents there is also a need to more clearly specify the type of offenders to whom the observed abnormal features most strongly apply. This more recent approach has made a distinction between sexual and non-sexual offenders. In their recent review, Van Wijk, Vermeiren, Loeber, ‘t Hart-Kerkhoffs, Doreleijers & Bullens [26] suggested that sexual offenders are more likely to display internalizing problems than non-sexual offenders and that findings regarding externalizing problems are less consistent in this group. The first aim of the present study was the comparison

of internalizing and externalizing problems, depressive symptoms and self-esteem among male non-detained ju- venile offenders, a male community group, and a clinical group of male adolescents attending a mental health ser- vice. More specifically, we assumed that based on self- reports the delinquent sample would show (a) higher levels of internalizing and externalizing problems and depressive symptoms and a lower self-esteem than the community sample and (b) similar scores in these measures when compared to the clinical sample. The second aim of the study was to compare the frequencies of psychiatric diagnoses after full clinical assessment. It