Childhood maltreatment and mental health problems in a 10-year follow-up study of adolescents in youth residential care: A latent transition analysis.

Childhood maltreatment and mental health problems are common among young people placed out-of-home. However, evidence on the impact of maltreatment on the course of mental health problems in at-risk populations is sparse. The aim of this longitudinal study is twofold: (a) describe the course of mental health problems and the shift in symptom patterns among adolescents in youth residential care into young adulthood and (b) assess how childhood maltreatment is related to the course of mental health problems. One hundred and sixty-six adolescents in Swiss youth residential care were followed up into young adulthood (36.1% women; MAge-Baseline = 16.1 years; MAge-Follow-Up = 26.4 years). Latent transition analysis was employed to analyze transitions of symptom patterns and their association with maltreatment exposure. We found three latent classes of mental health problems: a "multiproblem"-class (51.8% baseline; 33.7% follow-up), a "low symptom"-class (39.2% baseline; 60.2% follow-up), and an "externalizing"-class (9.0% baseline; 6.0% follow-up). Individuals in the "multiproblem"-class were likely to transition towards less-complex symptom patterns. Higher severity of self-reported childhood maltreatment was associated with more complex and persistent mental health problems. Our study underlines the need for collaboration between residential and psychiatric care systems within and after care placements, with a specialized focus on trauma-informed interventions and care.

Limited prosocial emotions (LPE) specifier in conduct disorder and offending behavior: findings from a 10-year prospective longitudinal study of juveniles in residential care.

BACKGROUND: Since the introduction of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, a limited prosocial emotion (LPE) specifier has been added to the conduct disorder (CD) diagnosis in addition to the age of onset specifier. It was suggested that this would identify a subgroup with severe antisocial and/or aggressive behavior with serious current and future (mental health) impairment. Research in recent years has shown that this is indeed a subgroup with severe antisocial behavior; however, mental health problems do not appear to differ from those of youth with CD without LPE. Most research to date has been cross-sectional. However, longitudinal research is urgently needed to better understand the predictive value of the LPE specifier. The aim of the current longitudinal study is to examine future offending behavior of youth with CD with compared to youth without the LPE specifier. In addition, the predictive value of the categorical LPE specifier and the dimensional LPE score will be examined beyond factors that are strongly associated with future offending (i.e., gender, age, and prior offending). METHODS: Adolescents and young adults (12-25) with CD (assessed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version [K-SADS-PL]) with (N = 61) and without (N = 75) the LPE specifier (assessed with the Callous-Unemotional [CU] dimension of the Youth Psychopathic traits Inventory [YPI]) (in line with Jambroes et al., 2016) were compared on sociodemographic characteristics, mental health problems and offending behavior. Future (general and violent) offending was based on official conviction data. RESULTS: Our results showed that youth with CD with and without the LPE specifier did not differ in self-reported and informant-reported mental health problems. However, youth with CD with the LPE specifier showed more offending behavior and personality pathology at baseline. In addition, the categorical LPE specifier was associated with future general offending, but not with future violent offending. The dimensional LPE score was associated with both future general and violent offending. However, after adjustment for gender, age, and prior delinquency, these associations disappeared, with the exception of the association between the dimensional LPE score and violent offending, which remained significant even after controlling for gender, age, and prior violent offending. DISCUSSION: In conclusion, there seems to be evidence of a relationship between limited prosocial emotions and future offending behavior in youth with CD. This relationship, however, should not be overestimated, as there are other (static) factors (e.g. gender and prior offending behavior) that also have a strong influence on future (violent) offending behavior. Still, from a clinical point of view, a dynamic factor like prosocial emotional skills is a good focus for reducing the risk of future offending behavior.

Mental disorders into adulthood among adolescents placed in residential care: A prospective 10-year follow-up study.

BACKGROUND: Child welfare and juvenile justice placed youths show high levels of psychosocial burden and high rates of mental disorders. It remains unclear how mental disorders develop into adulthood in these populations. The aim was to present the rates of mental disorders in adolescence and adulthood in child welfare and juvenile justice samples and to examine their mental health trajectories from adolescence into adulthood. METHODS: Seventy adolescents in shared residential care, placed by child welfare (n = 52, mean age = 15 years) or juvenile justice (n = 18, mean age = 17 years) authorities, were followed up into adulthood (child welfare: mean age = 25 years; juvenile justice: mean age = 27 years). Mental disorders were assessed based on the International Classification of Diseases 10th Revision diagnoses at baseline and at follow-up. Epidemiological information on mental disorders was presented for each group. Bivariate correlations and structural equation modeling for the relationship of mental disorders were performed. RESULTS: In the total sample, prevalence rates of 73% and 86% for any mental disorder were found in adolescence (child welfare: 70%; juvenile justice: 83%) and adulthood (child welfare: 83%; juvenile justice: 94%) respectively. General psychopathology was found to be stable from adolescence into adulthood in both samples. CONCLUSIONS: Our findings showed high prevalence rates and a high stability of general psychopathology into adulthood among child welfare and juvenile justice adolescents in Swiss residential care. Therefore, continuity of mental health care and well-prepared transitions into adulthood for such individuals is highly warranted.

Prevalence and 10-Year Stability of Personality Disorders From Adolescence to Young Adulthood in a High-Risk Sample.

Background: With the implementation of the 11th edition of the International Classification of Diseases (ICD-11) in early 2022, there will be a radical change in the framework and process for diagnosing personality disorders (PDs), indicating a transition from the categorical to the dimensional model. Despite increasing evidence that PDs are not as stable as previously assumed, the long-term stability of PDs remains under major debate. The aim of the current paper was to investigate the categorical and dimensional mean-level and rank-order stability of PDs from adolescence into young adulthood in a high-risk sample. Methods: In total, 115 young adults with a history of residential child welfare and juvenile-justice placements in Switzerland were included in the current study. PDs were assessed at baseline and at a 10-year follow-up. On a categorical level, mean-level stability was assessed through the proportion of enduring cases from baseline to follow-up. Rank-order stability was assessed through Cohen's κ and tetrachoric correlation coefficients. On a dimensional level, the magnitude of change between the PD trait scores at baseline and at follow-up was measured by Cohen's d. Rank-order stability was assessed through Spearman's ρ. Results: The prevalence rate for any PD was 20.0% at baseline and 30.4% at follow-up. The most frequently diagnosed disorders were antisocial, borderline, and obsessive-compulsive PDs, both at baseline and at follow-up. On a categorical level, the mean-level stability of any PD was only moderate, and the mean-level stability of specific PDs was low, except of schizoid PD. Likewise, the rank-order stability of any PD category was moderate, while ranging from low to high for individual PD diagnoses. On a dimensional level, scores increased significantly for most PDs, except for histrionic traits, which decreased significantly from baseline to follow-up. Effect sizes were generally low. The rank-order stability for dimensional scores ranged from low to moderate. Conclusion: The findings indicate low to moderate stability of Pds and Pd traits from adolescence to adulthood, which supports the growing evidence that categorical diagnoses of Pds are quite unstable. This in turn, emphasizes the use of the upcoming ICD-11 that Acknowledgments Pds to be only "relatively" stable.

Variants of girls and boys with conduct disorder: anxiety symptoms and callous-unemotional traits.

Recent research suggests that among the group of aggressive and antisocial adolescents, there are distinct variants who exhibit different levels of anxiety symptoms and callous-unemotional traits (CU traits). The purpose of the present study was to examine whether such variants are also present in male and female adolescents diagnosed with conduct disorder (CD). We used model-based cluster analysis to disaggregate data of 158 adolescents with CD (109 boys, 49 girls; mean age =15.61 years) living in child welfare and juvenile justice institutions. Three variants were identified: (1) CD only, (2) CD with moderate CU traits and anxiety symptoms, and (3) CD with severe CU traits. Variants differed in external validation measures assessing anger and irritability, externalizing behavior, traumatic experiences, and substance use. The CD variant with moderate CU traits and anxiety symptoms had the most severe pattern of psychopathology. Our results also indicated distinct profiles of personality development for all three variants. Gender-specific comparisons revealed differences between girls and boys with CD on clustering and external validation measures and a gender-specific cluster affiliation. The present results extend previously published findings on variants among aggressive and antisocial adolescents to male and female adolescents diagnosed with CD.