Are psychotic experiences among detained juvenile offenders explained by trauma and substance use?

Abstract

Objective

High rates of psychotic experiences among detained adolescents have been reported. However, the significance of psychotic experiences in detained juveniles is still poorly understood. The current study, therefore, (1) examines whether psychotic experiences could be explained by substance use and/or traumatic experiences, and (2) investigates this objective without taking into account the frequently occurring paranoia-related symptoms that may not be psychosis-related in detained minors.

Method

Data were derived from 231 detained adolescents. By means of the Diagnostic Interview Schedule for Children, psychotic experiences, life-threatening events and substance use were assessed while the Child Traumatic Questionnaire was used for a history of abuse and neglect.

Results

In univariate logistic regression analyses, having psychotic experiences was positively associated with substance-related (e.g. past year intense marihuana use) and trauma-related (e.g. emotional abuse) variables. However, without taken paranoia-related experiences into account, different associations between psychotic experiences and substance-related and/or trauma-related variables were found. After building best fitting models, logistic regression analyses demonstrated a preponderance of trauma-related over substance-related variables in predicting the number of psychotic experiences (i.e. 0, 1–2, >2).

Conclusion

These findings suggest that psychotic experiences in detained adolescents may be explained by trauma and substance use. In addition, paranoia-related experiences seemed to be particularly associated with emotional abuse.

Introduction

In contrast to the numerous reports on psychotic disorders in adult offenders, sound investigations of psychotic disorders in juvenile delinquents are rare. The few existing studies on psychotic disorders in adolescent detainees have provided prevalence rates ranging from 1% to 4% (Colins et al., in press, Gosden et al., 2003, Hollander and Turner, 1985, McManus et al., 1984, Richards, 1996, Teplin et al., 2002). When including psychotic experiences as described by van Os et al. (Johns and van Os, 2001, van Os et al., 2000), more studies in detained youths can be found, with rates from 25% up to 75% (Atkins et al., 1999, Teplin et al., 2002, Ulzen and Hamilton, 1998, Vreugdenhil et al., 2004). Most clinicians working with juvenile offenders will not agree that these enumerated psychotic experiences indicate a clinical psychotic disorder. At present, it is still unclear whether such experiences are really psychotic, or phenomena that occur in the range of other disorders (Vermeiren et al., 2006) In addition, a substantial proportion of the general population have psychotic experiences without having any psychiatric diagnosis, or without being in need for care (Escher et al., 2002, Hanssen et al., 2005, Nishida et al., 2008), suggesting that such experiences do not need to be markers of poor mental health.

As research in community and clinical samples shows a relation between childhood abuse and psychotic experiences (Janssen et al., 2004, Read et al., 2005), the high levels of childhood abuse in detained adolescents (Haapasalo and Hamalainen, 1996, Ulzen and Hamilton, 1998, Yoshinaga et al., 2004) may well account for the enumerated psychotic experiences. However, while most research has focused on the impact of physical and sexual abuse (Bernstein et al., 2003), there is an increasing body of evidence that different types of traumatic experiences have different psychopathological outcomes. Therefore, when studying the relation between psychotic symptomatology and trauma, screening for a history of emotional abuse and neglect, physical neglect and other life-threatening events is warranted (Chapman et al., 2004, Cohen et al., 1996, Spauwen et al., 2006, Wenar and Kerig, 2006). The high numbers of psychotic experiences in detained youth could also be explained by their high rates of illegal substance use (marihuana, amphetamines and cocaine) (Vreugdenhil et al., 2003), especially because these three substances are likely to be associated with the expression of psychotic experiences (Thirthalli and Benegal, 2006). The most systematic evidence is, however, available for marihuana, which has frequently been reported to exacerbate psychotic experiences (Arseneault et al., 2002, Henquet et al., 2005, Thirthalli and Benegal, 2006). Finally, because childhood traumatic experiences are also associated with substance use (Crimmins et al., 2000, De Bellis, 2002), psychotic experiences in detained youth may be related simultaneously to substance use and trauma. Therefore, it is important to examine whether substance use only, trauma only or both are significantly associated with psychotic symptomatology when both substance- and trauma-related variables were examined. If, for example, significant associations between substance use disappear after controlling for trauma, while these trauma-related variables remain significant, this may suggest that substance use plays an important role in the association between trauma and psychotic experiences. However, most studies that examined the relation between substance use and psychotic experiences and adjusted for trauma, did not present the strength of the association between trauma and psychotic disorder (e.g. Fergusson et al., 2005, Henquet et al., 2005). Likewise, studies that examined the relation between trauma and psychotic experiences and adjusted for substance use, did not present the strength of the relation between substance use and psychotic disorder (e.g. Janssen et al., 2004).

To the best of our knowledge, this is the first study that specifically was designed in order to better understand the relation between psychotic experiences in detained juveniles on the one hand and substance use and trauma on the other. Based on existing literature, the following research questions were addressed. First, would a large proportion of detained boys report at least one psychotic experience? Second, what proportion of participants with at least on psychotic experience met criteria for comorbid psychiatric disorders? (We anticipated that only a small percentage of participants with psychotic experiences would be diagnosed with a psychotic disorder according Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), in contrast to other psychiatric disorders. Third, would trauma-related variables be positively associated with psychotic experiences and substance related variables? Fourth, when traumatic experiences and illegal substance use are considered simultaneously, would both jointly be positively associated with psychotic experiences, controlling for potential confounders (age, origin, socioeconomic status) known from the literature (Janssen et al., 2003, Janssen et al., 2004, Veling et al., 2007). Last, because juvenile detainees are expected to show high levels of paranoia-related experiences that may be related to their history and current legal status, for example because they are secretly being watched during detention (e.g. spy hole), would the same relationships be found when excluding paranoia-related features from the psychotic experience variable?