The percentage of repeat offenders is increasing among juvenile offenders in Korea. The assessment and treatment of the mental health of young offenders may play an important role in reducing the recidivism rate of adolescents. This study examined the prevalence of psychiatric disorders among adolescents on probation or parole and the risk of recidivism associated with specific psychiatric disorders.
We studied 120 adolescents on probation. The Mini-International Neuropsychiatric Interview and Conners’ Rating Scale-Revised were used to diagnose psychiatric disorders.
Almost half of the juvenile offenders had psychiatric disorders, including alcohol use disorder (19.17%), bipolar disorder (18.33%), antisocial personality disorder (11.67%), and attention-deficit/hyperactivity disorder (10.83%). Alcohol use disorder was significantly associated with repeated offenses, but psychiatric disorders, excluding alcohol use disorder, were not significantly associated with repeated offenses.
These results suggested that the development of education and treatment programs for psychiatric disorders, including alcohol use disorder, among juvenile offenders on probation or parole may help to prevent repeated criminal behaviour.
The number of juvenile offenders in Korea has increased by 29.4% since 2002, and they account for 5.1% of all criminal offences [
In western nations, the increasing numbers of young offenders have stimulated studies on the prevalence of mental illnesses among young offenders. Among these studies, the percentages of these disorders vary: substance use disorder (13–50%), major depressive disorder (6.3–29.2%), psychosis (2.7–11.3%), conduct disorder (31–52.8%), attention deficit/hyperactivity disorder (ADHD; 11.3–45%), and personality disorder (36%) [
In Korea, few domestic studies have been conducted on mental illness in juvenile criminals. Park [
Among juveniles, the percentage of first-time offenders has been gradually decreasing, whereas the percentage of repeat offenders has been increasing [
In order to improve the mental health and recidivism rate of young offenders, a comprehensive investigation of mental illnesses among domestic young offenders is needed. In the present study, we investigated the prevalence of psychiatric disorders among adolescents on probation or parole and the risk of recidivism according to specific psychiatric disorders with both structured interviews and self-report surveys at a probation centre in Korea. We hypothesized that individuals with psychiatric disorders have a greater recidivism risk.
This preliminary study investigated mental illnesses in adolescent inmates in South Korea. Probation is a system to prevent recidivism and to help returning to society by correcting and rehabilitating juvenile offenders without accepting them at the correctional institution. Juvenile offenders should attend the lecture at the probation center during probation. Of the probation cases, including intensive, major, and general supervision probation, adolescents less than 19 years old who visited the probation office in Seoul because of orders to attend a lecture between August 6, 2014 and November 19, 2014 were selected as subjects. The purposes and procedures of the study were explained to the participants, and 120 participants volunteered. Written informed consents were obtained, and self-report tests and interviews by psychiatrists and clinical psychologists with appropriate educational credentials were administered after mandatory treatment.
This study was reviewed and approved by the Institutional Review Board of Sanggye Paik Hospital (SPIRB-2015-01-012) and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.
We conducted self-report tests and structured diagnostic interviews to assess the demographic characteristics and prevalences of psychiatric disorders among the participants.
Age, gender, socioeconomic status, and number/type(s) of crimes committed were recorded for each participant. The participants’ living situations were recorded as living with both parents, a single parent, or non-parent(s). Annual family income was recorded as less than 10 million, 10–20 million, 20–30 million, or greater than 30 million won. Recidivism was defined as prior involvement with the criminal justice system. Those sentenced to their first probation were classified as the first offense group, while those on probation two or more times were classified as the repeat offense group. The reason for probation was recorded as a property crime (e.g., theft, fraud, or blackmail), violent crime (e.g., murder, robbery, assault, or arson), sex crime (e.g., rape or sexual assault), drug-related crime, domestic violence, traffic violation, obstruction of law enforcement, impaired driving, or other crimes.
The revised Mini-International Neuropsychiatric Interview (MINI) [
We used the Conners-Wells’ Adolescent Self-Report Scale: Short Form to diagnose ADHD. This test is a self-report test for adolescents that is part of the Conners’ Rating Scale-Revised used by parents, teachers, and youth for diagnosing ADHD. The scale consists of 27 questions with the answers ranked on a Likert scale from 0 (not true at all) to 3 (very frequently). The questions assess cognitive factors, hyperactivity, conduct problems, and an ADHD index. The minimum score for an ADHD diagnosis is 41 points at 13–14 years of age, 44 points at 15, and 42 points at 16–18. In this study, we used a 42-point criterion because the mean age of the participants was 16.34 years. The internal consistency (Cronbach’s α) of the Conners-Wells’ Adolescent Self-Report Scale: Short Form is 0.88 [
Descriptive analyses were used to estimate the prevalences of psychiatric disorders and percentages of participants according to demographic characteristics and probation reasons. Chi-square tests were used to assess the differences between first-time and repeated offenders. We predicted that recidivism would differ according to the presence of psychiatric disorders via logistic regression. The covariates included age, gender, living with parents, annual family income, probation reason, and suicidality as in previous studies [
The mean age of the participants was 16.34 years (standard deviation, 1.54). Ninety-seven participants (80.8%) were men, and 23 (19.2%) were women. Fifty-three participants (44.2%) lived with both parents, 56 (46.7%) lived with one parent, and 11 (9.2%) lived with grandparents, siblings, or a spouse. Only 68 participants responded to the question regarding annual family income; of these, 12 (10.0%) reported an annual family income of less than 10 million won, 25 (20.8%) reported 10–20 million won, 15 (12.5%) reported 20–30 million won, and 16 (13.3%) reported more than 30 million won. Fifty-seven participants (47.5%) were first-time offenders, and 63 (52.5%) were repeat offenders. For offense number, 57 (47.5%), 36 (30.0%), 17 (14.2%), and 10 (8.3%) committed a first, second, third, and over four crimes, respectively.
Multiple responses were permitted, and only 1 participant did not answer. Fifty-eight participants (48.7%) committed property crimes (e.g., theft, fraud, or blackmail), 33 (27.7%) committed violent crimes (e.g., murder, robbery, assault, or arson), 4 (3.4%) committed sex crimes (e.g., rape or sexual assault), and 15 (12.6%) committed traffic violations. Two (1.7%) were arrested for impaired driving, 2 (1.7%) obstructed law enforcement, 1 (0.8%) was arrested for narcotics possession, 1 (0.8%) committed domestic violence, and 14 (11.7%) committed other crimes, such as manipulation of official documents, defamation of character, or breaking and entering.
Alcohol use disorder was significantly associated with recidivism before covariate adjustment [odds ratio (OR), 3.080; 95% confidence interval (CI), 1.118–8.483]. However, the association was no longer significant after adjusting for age, gender, living with parents, annual family income, probation reason, and suicidality (OR, 5.524; 95% CI, 0.597–51.140).
Many juvenile offenders had psychiatric disorders, including alcohol use disorder, bipolar disorder, antisocial personality disorder, ADHD, schizophrenia, and major depressive disorder, in our study. The prevalences of psychiatric disorders in studies conducted in western countries were the following: alcohol abuse/dependence (4.7–6.4%), bipolar disorder (1.7–6.8%), ADHD (0.9–8.7%), and major depressive disorder (2.2–5.3%).17-19 Park et al. [
Of the juvenile offenders in our study, 30% expressed suicidal ideation. A study of Korean adolescents in 10 juvenile correctional facilities (n=1,682) reported that 15.2% had suicidal ideation during the past year [
The prevalence of alcohol use disorder was higher among repeat offenders than among first-time offenders. Substance use during childhood and adolescence predicts criminal behaviour [
Except for alcohol use disorder, psychiatric disorders were not significantly associated with repeated crime in the present study. Similarly, a Belgian study of detained male adolescents (n=232) reported that common psychiatric disorders did not predict recidivism, while substance use and comorbid disorders increased the risk of substance-related recidivism [
The present study had several limitations. First, self-report tools on participant demographics, probation, and diagnoses were used. Therefore, the information may have been distorted by the participants. In addition, some participants did not respond to some questions, which decreased the data reliability. Second, the MINI, which was used to diagnose psychiatric disorders, does not fully cover children and adolescent psychiatric diagnosis. Thus, its use in children and adolescents may be limited. In addition, the Conners’ Rating Scales were not sufficient to confirm ADHD diagnoses. Effective evaluations require tools that diagnose childhood- or adolescent-specific disorders, including oppositional defiant disorder, conduct disorders, ADHD, separation anxiety disorder, encopresis, and enuresis, such as the Korean version of the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version. Future research should use a structured and objective diagnostic instrument and interviews with both adolescent participants and their parents to diagnose and evaluate psychiatric disorders. Third, the current findings do not allow conclusions about causalities between mental illness and recidivism. Longitudinal studies are needed to identify causal relationships. Last, generalisations of the results of our study are difficult because we studied a small number of adolescents from a single probation centre. Future studies should examine adolescents at multiple juvenile justice facilities, including those for system intake, detention, and probation.
The results of the present study demonstrated that adolescents on probation or parole had high incidences of psychiatric disorders, including alcohol use disorder, bipolar disorder, antisocial personality disorder, ADHD, schizophrenia, and major depressive disorder. Alcohol use disorder was significantly associated with repeated crime, while other psychiatric disorders were not. These results suggest that educational and treatment programs for psychiatric disorders, including alcohol use disorder, for juvenile offenders on probation or parole may help to prevent repeated criminal behaviour. Further research is needed at multiple juvenile justice facilities to accurately and comprehensively understand the effects of the juvenile offense conditions.
This study was supported by a research fund from Seoul National Hospital, Ministry of Health & Welfare, Republic of Korea.
Psychiatric disorders among the participants (N=120)
Diagnosis | Number of participants (%) |
---|---|
Total psychiatric disorders | 53 (44.2) |
Major depressive disorder | 7 (5.8) |
Dysthymia | 1 (0.8) |
Bipolar disorder | 22 (18.3) |
Panic disorder | 1 (0.8) |
Agoraphobia | 6 (5.0) |
Social phobia | 3 (2.5) |
Obsessive-compulsive disorder | 2 (1.7) |
Posttraumatic stress disorder | 2 (1.7) |
Alcohol use disorder | 23 (19.2) |
Schizophrenia | 7 (5.8) |
Generalised anxiety disorder | 2 (1.7) |
Antisocial personality disorder | 14 (11.7) |
ADHD | 11 (9.2) |
Suicidality | 36 (30.0) |
Dual diagnoses were allowed. ADHD: attention-deficit/hyperactivity disorder
Demographic characteristics in first-time and repeat offenders (N=120)
First-time offenders (N=57) | Repeat offenders (N=63) | p value | |
---|---|---|---|
Age: mean (SD) | 15.89 (1.72) | 16.75 (1.24) | 0.002 |
Gender | 0.335 | ||
Men | 44 (77.2) | 53 (84.1) | |
Women | 13 (22.8) | 10 (15.9) | |
Living situation | 0.312 | ||
Both parents | 27 (47.4) | 26 (41.3) | |
Single parent | 23 (40.4) | 33 (52.4) | |
No parent | 7 (12.3) | 4 (6.3) | |
Annual family income | 0.336 | ||
Less than 10 million won | 7 (12.3) | 5 (7.9) | |
10–20 million won | 13 (22.8) | 12 (19.0) | |
20–30 million won | 4 (7.0) | 11 (17.5) | |
More than 30 million won | 7 (12.3) | 9 (14.3) |
Unless otherwise noted, data are presented as number (%). SD: standard deviation
Relationships between psychiatric disorders and repeated crime (N=120)
First-time offenders (N=57) | Repeat offenders (N=63) | p value | |
---|---|---|---|
Total psychiatric disorders | 24 (42.1) | 29 (46.0) | 0.665 |
Major depressive disorder | 4 (7.0) | 3 (4.8) | 0.707 |
Dysthymia | 1 (1.8) | 0 (0) | 0.475 |
Bipolar disorder | 10 (17.5) | 12 (19.0) | 0.832 |
Panic disorder | 1 (1.8) | 0 (0) | 0.475 |
Agoraphobia | 4 (7.0) | 2 (3.2) | 0.422 |
Social phobia | 2 (3.5) | 1 (1.6) | 0.604 |
Obsessive-compulsive disorder | 2 (3.5) | 0 (0) | 0.224 |
Posttraumatic stress disorder | 2 (3.5) | 0 (0) | 0.224 |
Alcohol use disorder | 6 (10.5) | 17 (27.0) | 0.022 |
Schizophrenia | 4 (7.0) | 3 (4.8) | 0.707 |
Generalised anxiety disorder | 2 (3.5) | 0 (0) | 0.224 |
Antisocial personality disorder | 7 (12.3) | 7 (11.1) | 0.842 |
ADHD | 7 (12.3) | 4 (6.3) | 0.261 |
Suicidality | 22 (38.6) | 14 (22.2) | 0.051 |
Unless otherwise noted, data are presented as number (%). ADHD: attention-deficit/hyperactivity disorder