detained adolescent females’ multiple mental health and adjustment problem outcomes in young...

Detained adolescent females’ multiple mentalhealth and adjustment problem outcomes

in young adulthood

E. van der Molen,1 R.R.J.M. Vermeiren,1,2 A.A. Krabbendam,1 A.T.F. Beekman,3

T.A.H. Doreleijers,2 and L.M.C. Jansen2

1Department of Child- and Adolescent Psychiatry, Leiden University Medical Center, Leiden, the Netherlands;2Department of Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam, the Netherlands;

3Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands

Background: Although prior studies have shown that detained females are marked by significant ad-verse circumstances, little is known about their adult outcomes. Method: Prospective follow-up studyof 184 (80.4% of original sample of 229) detained adolescent females who were reassessed 4.5(SD = 0.6) years later in young adulthood (mean age = 20.0, SD = 1.4) on mental health and adjustmentoutcomes. Associations between these outcomes and detained females’ behavior problems and offensehistory were examined. Results: In the total sample, 59.0% had one or more mental health problems atfollow-up, whereas 96.2% were facing at least one adjustment problem. Subjects with a personalitydisorder (PD) reported more adjustment problems compared to subjects without PD. Mental health andadjustment problems in young adulthood were predicted by detained adolescent females’ behaviorproblems and offense history. Conclusion: Detained adolescent females suffered from multiple mentalhealth and adjustment problems in young adulthood. Females who developed PD were most impaired.Results of this study underline the compelling need for continued and gender-specific interventions. Theidentification of predictors during detention for poor adult outcomes can serve as targets for interven-tion. Keywords: Follow-up, detention, females, adult outcome.

IntroductionOver the last decades, the number of female youthsfacing detention has increased substantially (Snyder& Sickmund, 2006). As delinquency rates are tradi-tionally higher for male youths, female youths havebeen neglected in most research on detained youth(Vermeiren, 2003). For a long time, it was thoughtthat female youths’ antisocial behavior was lesssevere, in contrast to similar behavior in males (Pa-jer, 1998). Recent findings, however, demonstrateotherwise for detained females. Detained femaleadolescents bear more severe problems than maleadolescents, such as higher rates of substanceabuse, physical, emotional, and sexual maltreat-ment, and familial risk for mental disorders (Abram,Teplin, McClelland, & Dulcan, 2003; McCabe, Lan-sing, Garland, & Hough, 2002). These detrimentalcircumstances could put detained adolescentfemales at risk for continued negative developmentinto adulthood.

Developmental theories of antisocial behavior sug-gest that behavioral manifestations of conduct prob-lems change over the lifespan (Sameroff, Peck, &Eccles, 2004). The severity of detained females’ men-tal health and related problems found relatively fre-quently among female adolescents (such as a historyof abuse) are likely to affect their development intoadulthood differently than for male adolescents. For

example, there is a growing recognition that femaleadolescents’ antisocial behavior is associated with awider range of long-term risks than young male ado-lescents antisocial behavior (Gorman-Smith, 2003).This is supported by results from nondetained sam-ples of antisocial females that indicate adjustmentproblems across multiple dimensions in adulthood,including mental health, substance dependence,early pregnancy, and intimate partner violence (e.g.,Moffitt, Caspi, Rutter, & Silva, 2001; Odgers et al.,2008).

However, current longitudinal studies on detainedyouth that have included female adolescents focusmainly on the single outcome of reoffending (e.g.,Cernkovich, Lanctot, & Giordano, 2008; Colman,Kim, Mitchell-Herzfeld, & Shady, 2009). A sub-stantial proportion of detained female adolescentswere found to desist from future offending, withactual delinquent behavior being less serious andpersistent compared to male adolescents. This sug-gests that problems are relatively benign and arelikely to fade with age. The few studies, includingoutcomes other than offending showed less positiveresults. For example, the Cook County prison sam-ple reported that most female adolescents wereseverely impaired on domains, such as school andwork, behavior toward others, emotions, self-harm-ful behavior, and substance use 3 years afterdetention (Abram, Choe, Washburn, Romero, & Te-plin, 2009). In addition, detained female adolescentsare associated with socioeconomic disadvantage,Conflict of interest statement: No conflicts declared.

Journal of Child Psychology and Psychiatry 54:9 (2013), pp 950–957 doi:10.1111/jcpp.12044

� 2013 The Authors. Journal of Child Psychology and Psychiatry � 2013 Association for Child and Adolescent Mental Health.Published by John Wiley & Sons Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main St, Malden, MA 02148, USA

violent relationships, and high pregnancy rates atfollow-up (Kerr, Leve, & Chamberlain, 2009; Lanctot,Cernkovich, & Giordano, 2007). Thus, detainedadolescent females are at risk to experience a varietyof adjustment problems in young adulthood.

As few studies have addressed adult outcomes ofdetained adolescent females, several issues needfurther consideration. First, we know little aboutdetained female adolescents’ mental health inadulthood. Current knowledge is restricted to spe-cific mental health problems, such as substance useand self-harmful behavior (Abram et al., 2009;Lanctot et al., 2007). Given the lifetime persistenceof mental health problems (Copeland, Shanahan,Costello, & Angold, 2009), the high rates of psychi-atric disorders found among detained female ado-lescents (Abram et al., 2003; Hamerlynck et al.,2007) are a cause for concern. For example, traumaexposure and post-traumatic stress disorder (PTSD),both common among detained female adolescents,are suggested to predispose to the development offurther psychopathology, such as substance abuse(Dixon, Howie, & Starling, 2005). In addition,detained female adolescents have many risk factorsfor developing personality disorders (PDs), such asantisocial personality disorder (APD) and BorderlinePersonality Disorder (BPD) (Atkins et al., 1999;Washburn et al., 2007). Second, no study ondetained female adolescents has examined a broadarray of adult adjustment problems, including gen-der-specific outcomes such as early motherhood andabortion. In this study, a multiple-outcomeapproach was used to describe adjustment prob-lems. Furthermore, it is conceivable that previouslydetained young women with mental health problemshave more adjustment problems than young womenwithout such problems. In particular, detained fe-male adolescents who developed a PD may have in-creased levels of adjustment problems, as thesedisorders are highly associated with disability (Grantet al., 2004). Therefore, we examined the relation-ship between mental health and adjustment prob-lems in young adulthood. Finally, detainedadolescent female adolescents’ behavioral problemsmay play a negative role in future achievements.Understanding detained female adolescents’ devel-opment into adulthood is important for determiningtargets for intervention and identifying female ado-lescents at risk for specific adverse outcomes.Therefore, we examined whether female adolescents’behavior (e.g., conduct problems, hyperactivity, andpeer problems) and offense history as assessedduring detention predict mental health and adjust-ment problems in young adulthood.

In sum, the present study aimed to examine abroad array of problems of previously detainedfemales. We aimed to extend current knowledge: (a)by describing detained female adolescents’ mentalhealth (both axis 1 mental problems and PDs) andadjustment problems in young adulthood, (b) by

investigating the extent to which these are associ-ated, and (c) by testing whether these young adultoutcomes can be predicted by detained female ado-lescents’ behavior and offense history.

MethodParticipants

Subjects were participants from a previous cross-sec-tional study on Dutch detained adolescent girls between2002 and 2004 (Hamerlynck et al., 2007). In that study,256 female adolescents were approached for participa-tion in their firstweekof admission, ofwhom229 (89.5%)agreed to participate (mean age = 15.6, SD = 1.4).

Subjects were recruited from three of the seven youthdetention centers that provided placement for femaleadolescents in the Netherlands. The total number ofDutch detained female adolescents was subsequently531, 616, and 700 in the years 2002–2004. Becausedetention in a specific center was based on cell avail-ability and no specific entry criteria were applied, youthdetention centers housed females from all over thecountry. Therefore, the sample was considered repre-sentative of the population of Dutch detained females.

At the time of the initial study, Dutch youths could beplaced in detention centers under two judicial condi-tions: (a) for a criminal act under criminal law, (b) as ajudicial civil measure of child protection, primarilywhen having committed a status offence 1 (e.g., sub-stance use, running away).

For the current study, 184 of the 229 subjects(80.3%) were reassessed between 3.5 and 6.7 years(mean 4.5 years, SD = 0.5) following the initial study. Ofthe original sample, 10.9% refused participation, 7.9%were untraceable, and 0.9% subjects died before follow-up. The mean age of subjects at follow-up was20.0 years (SD = 1.4) and ranged from 16 to 24 years;16 (8.7%) subjects were younger than 18 years old. Themajority were of Dutch (57.6%) or other western origin(6.5%), whereas 35.9% had a non-Western background.

Follow-up participants did not differ from the rest ofthe sample on initial levels of conduct problems(t = )0.18, df = 227, p = .86), hyperactivity/inattention(t = )0.82, df = 227, p = .41), peer problems (t = 0.16,df = 227, p = .87), emotional problems (t = 0.01, df =227, p = .99), and total difficulties (t = )0.30, df = 227,p = .76) during detention. There were also no differ-ences between the number of offenses committed afterdetention (t = )0.52, df = 227, p = .61), and whetherthey committed a violent offense (v2 (1) = 0.11, p = .74).However, retained subjects were younger (mean age= 15.5, SD = 1.3) compared to those lost to follow-up(mean age = 16.1, SD = 1.5; t = 2.41, df = 227, p = .02).

Procedure

The study was approved by the review boards of theMinistry of Justice and by the VU University MedicalEthics Committee. At follow-up, written informed

1

Unlike other western countries, such as theUnited States, status offenses are not defined ascrime in the Netherlands.

doi:10.1111/jcpp.12044 Young adult outcome of detained females 951

� 2013 The Authors. Journal of Child Psychology and Psychiatry � 2013 Association for Child and Adolescent Mental Health.

consent was obtained prior to data collection. Inter-views were conducted at the homes of the subjects(82.6%), or at residential placement (14.1%) and cor-rectional facilities (3.3%). Subjects were paid a stipendfor their time.

Dependent measures

Mental health outcomes. The axis I problemsattention-deficit/hyperactivity disorder (ADHD), sub-stance dependence, and suicidal and self-harmfulbehavior were assessed using the Kiddie-SADS-Presentand Lifetime Version (K-SADS-PL; Kaufman et al.,1997; Dutch translation by Reichart, Wals, & Hillegers,2000). The K-SADS-PL is a semistructured diagnosticinterview designed to assess psychiatric disorder inyouth according to criteria listed in the Diagnostic andStatistical Manual of Mental Disorders-IV (DSM-IV;American Psychiatric Association, 1994). Substancedependence in the past year was measured (alcohol,cannabis, stimulants, sedatives, cocaine, opioids, PCP,hallucinogens, inhalants, and others, such as ecstasy)and data were reduced to a binary variable indicatingany substance dependence. Suicidal attempt wasdefined as any suicidal attempt in the last year and self-harm as any act of self-injury (e.g., skin cutting) in thepast year. Depression was measured using the BeckDepression Inventory (BDI; Beck, Ward, Mendelson,Mock, & Erbaugh, 1961; Dutch translation by Schotte,Maes, Cluydts, De Doncker, & Cosyns, 1997). The scaleincludes 21 items on depressive symptoms over thepast week on a 4-point scale (ranging from 0 = absent,to 3 = severe). In this study, the internal consistencycoefficient of the depression scale was a = 0.86. A cut-off score of 19 was used indicating the clinical range ofdepression (Beck & Beamesdefer, 1974). Post-TraumaticStress Disorder was examined using the Child Post-Traumatic Stress Disorder-Reactivity Index (CPTSD-RI;Pynoos, Frederick, Nader, & Arroyo, 1987). The CPTSD-RI is designed to assess post-traumatic stress symp-toms following exposure to traumatic events. TheCPTSD-RI consists of 20 items on a 5-point scale(ranging from 0 = none, to 4 = most of the time). Cro-hnbach’s a was 0.90. The cut-off score of 40 (indicativeof ‘severe’ PTSD) was used (Pynoos et al., 1993). Dis-sociation was measured using the Dissociation Ques-tionnaire (DIS-Q; Vanderlinden, Van Dyck,Vandereycken, Vertommen, & Verkes, 1993). The DIS-Q consists of 63 items on a 5-point scale (ranging from1 = not at all present, to 5 = very present). The internalconsistency of this scale was a = 0.80. We used meanscores above 2.5 as a cut-off, which is consideredindicative of a dissociation disorder. The PDs, BPD andAPD, were examined using the Structured ClinicalInterview for DSM-IV Axis II Personality Disorders(SCID-II; First et al., 1995; Dutch translation by We-ertman, Arntz, & Kerkhofs, 1997). We adjusted theDSM-IV age criterion requirement for APD diagnoses.According to the DSM IV, APD may not be diagnoseduntil age 18 years. Part of our sample was younger thanage 18 (8.7%), most turning 18 within a year and thusincluded in the study.

Adjustment problem outcomes. Demographic andsocial outcomes were collected to examine adjustment

problems. Data were reduced to binary variables(0 = no, 1 = yes) indicating the least favorable outcome.Subjects with no high school diploma at follow-up wererated as having poor educational attainment. Subjectswere considered as having an unfavorable school/worksituation when they did not have a job or attend schoolat follow-up. Financial debts were rated as problematicif the debt was over 1000 euros. Public assistanceincluded subjects receiving financial benefits from thegovernment (i.e., unemployment pay and mental/physical disability benefits). A measure of physicalpartner violence was created and indicated any physicalaggression in a subjects’ intimate relationship(s) afterdetention (including aggression toward the participant,aggression toward the partner or mutual aggression).Abortion was rated for induced abortion(s) of pregnancyafter detention and early motherhood was rated forsubjects that had given birth to a child under the age of20. A measure of prostitution was created including anyexchange of direct sexual services for payment (and didnot include indirect exchanges such as phone-sex).Subjects scored positive on delinquent after detentionwhen they committed any offense after detention. Forthese data, national crime figures from the Dutch PoliceRecord System (Herkenningssysteem) were used thatpertain to all criminal offenses the subjects were sus-pects of. The variable adulthood detention indicatedsubjects’ detention at some time in adulthood and wascreated using the TULP registration, the official Dutchjudicial registration system on adult detention.

A total adjustment problem score was created bysumming all adjustment problems. In addition, wecreated three adjustment problem dimensions: (a)occupation, education, and financial (i.e. no high schooldiploma, unfavorable school/work situation, financialdebts, public assistance), and (b) sexual and relation-ship (i.e. physical partner violence, abortion, earlymotherhood, prostitution). We decided to examinedelinquent after detention as the outcome of thedimension (c) delinquent behavior, due to the overlap-ping constructs (i.e., delinquent after detention andadulthood detention).

Predictors from detained adolescent females usedin regression analyses

Behavior problems. Detained subjects’ rated theStrengths and Difficulties Questionnaire (SDQ; Good-man, 1997; Dutch translation by Goedhart, Treffers, &Van Widenfelt, 2003) in the first month of detention,and the subscales Conduct problems, Hyperactivity/inattention, Peer problems, and Emotional Problemswere used to investigate behavioral problems. Eachsubscale consists of five items on a 3-points scale(ranging from 0 = not true to 2 = certainly true). Sub-scales were summed to generate the Total difficultiesscore (Crohnbach’s a = .75).

Offense history. To examine the number of offensesthat subjects committed prior to detention, data fromthe Dutch Police Records System (Herkenningssysteem)were used. Subjects’ violent offenses were reduced to abinary score, indicating any violent offense committedprior to detention.

952 E. van der Molen et al. J Child Psychol Psychiatry 2013; 54(9): 950–7


Data analyses

First, descriptive statistics were performed to describeyoung adult mental health and adjustment problems.Next, we examined whether mental health problemswere associated with increased adjustment problems inadulthood. Mean total adjustment problem scores werecompared between subjects with: only axis I problems(Axis1), personality disorder(s), and no mental healthproblems (NoMH) using analyses of variance (ANOVA).Post-hoc pair-wise comparisons were adjusted formultiple comparisons using the Bonferroni procedure.Finally, we examined whether young adult outcomeswere predicted by detained female adolescents’ behav-ioral problems and offense history using regressionanalyses. For these analyses, we distinguished betweenthe following adult outcomes: mental health problemsand each of the adjustment problem dimensions (i.e.,occupational, educational, and financial, sexual andrelationship, and delinquent behavior). All outcomevariables were controlled for time to follow-up, time indetention, and age. Because of the multiple tests con-ducted, we used a Bonferonni correction (i.e., the levelof significance was set at .007, .05 divided by 7 pre-dictors) for these regression analyses.

Missing data were prorated if at least 67% of theitems within instruments were completed. We selectedp < .05 to indicate statistical significance. SPSS soft-ware (Version 16.0, 2007: SPSS Inc, Chicago, IL, USA)was used for statistical analyses.

ResultsPrevalence rates of detained females’ mental healthproblems in young adulthood are listed in Table 1. Atfollow-up, most subjects (59.0%) had at least onemental health problem. Substance dependence wasthe most common mental health condition, whereas32.8% of the subjects had at least one internalizingproblem (i.e., depression, PTSD, dissociation, self-injury, and suicide attempt). Furthermore, 40.2%had developed one or both PDs (i.e., BPD and/or

APD). A substantial proportion (41.5%) had comor-bid disorders in young adulthood. Mental healthproblems were more accumulated (t = )5.42,df = 106, p < .001) among subjects with a PD(M = 3.53, SD = 2.03) compared with subjects withonly axis 1 problems (M = 1.79, SD = 1.27).

Table 2 presents finding on detained female ado-lescents’ adjustment problems in young adulthood.Nearly all subjects faced multiple adjustment prob-lems in young adulthood (M = 4.02, SD = 2.01), withonly 7 (3.8%) subjects reporting no problems. A highproportion (85.9%) had at least one difficulty withinthe occupational/educational/financial dimension(M = 1.98, SD = 1.25), and 57.4% on the sexual/relational dimension (M = 0.76, SD = 0.75). Almostone out of five subjects had a child at a very youngage (<20). As for delinquent behavior, 61.4% of-fended after detention, which resulted in adultdetention for 13.6%. Subjects committed on average1.98 (SD = 2.88) offenses after detention.

Next, we tested whether subjects with mentalhealth problems in young adulthood had higherlevels of adjustment problems compared to subjectswithout mental health problems. For these analyses,we distinguished between subjects diagnosed with aPD (PD; N = 74), subjects with only axis I problems(axis I; N = 34), and subjects without any mentalhealth problems (NoMH; N = 76). Figure 1 showsthat compared to the NoMH and axis I subjects, PDsubjects had a higher total amount of adjustmentproblems (F = 15.53, df = 2, p < .001). Similarly, PDsubjects had more occupation, education, andfinancial problems (F = 11.60, df = 2, p < .001,PD > axis 1, NoMH), and also offended more fre-quently after detention (F = 8.20, df = 2, p < .001,PD > axis 1, NoMH) than axis 1 and NoMH subjects.Axis I subjects were not different from subjectswithout mental health problems. Comparisons onthe sexual and relationship dimension failed to reachsignificance, indicating that problems on this

Table 1 Young adult mental health of detained adolescent fe-males

Mental health variables N %

Depression 36 19.8PTSD 36 19.7Dissociation 17 9.5Suicidal attempt 15 8.2Self-injury 24 13.1Substance dependence 64 34.8ADHD 27 14.8Personality disorder variablesBPD 45 24.5APD 57 31.0

‡1 Mental health problem(s) 108 59.0‡2 Mental health problems 76 41.5

ADHD, attention-deficit/hyperactivity disorder; APD, antiso-cial personality disorder; BPD, Borderline Personality Disor-der; PTSD, post-traumatic stress disorder.Total N ranged between 179 and 184 due to missing data.

Table 2 Young adult adjustment problems of detained ado-lescent females

Adjustment problem dimensions N %

Occupational/educational/financialNo high school diploma 114 62.0No school, no work 89 48.4Financial debt 98 53.3Public assistance 63 34.2

Delinquent behaviorDelinquent after detention 113 61.4Adulthood detention 25 13.6

Sexual/relationalPhysical partner violence 96 53.6Abortion 72 39.1Early motherhood 35 19.0Prostitution 32 17.5

M SD

Total number of adjustment problems 4.0 2.0

Total N ranged between 179 and 184 due to missing data.



dimension were not associated with subjects’ mentalhealth.

In the final step, we evaluated predictors duringdetention for mental health and adjustment prob-lems at follow-up. As shown in Table 3, detained

subjects’ high scores on the emotional symptoms(b = 0.22, 95% CI = 0.09–0.34, p = .0009), and thetotal difficulties scale (b = 0.08, 95% CI = 0.03–0.14,p = .0040) increased the likelihood of mental healthproblems in young adulthood, while controlling fortime to follow-up, time in detention, and age. Otherbehaviors and offense history characteristics failedto reach significance for mental health outcomes.

Table 4 illustrates that young adult adjustmentproblems on the occupation, education, and financialdimension were predicted by detained subjects’higher scores on hyperactivity/inattention (b = 0.12,95% CI = 0.04–0.21, p = .0042), emotional symp-toms (b = 0.12, 95% CI = 0.05–0.20, p = .0012), andthe total difficulties scale (b = 0.06, 95% CI = 0.03–0.09, p = .0006). Other behaviors during detentionwere not predictive of this dimension. In addition,none of the predictors was significantly associatedwith the sexual and relationship dimension. Subjectsthat offended more often before detention, offendedalso more frequently after detention (b = 0.08, 95%CI = 0.04–0.11, p < .0000).

DiscussionThis study extends knowledge on detained adoles-cent females’ mental health and adjustment prob-lems in early adulthood. Previous research hasfocused primarily on delinquency outcomes. Thecurrent findings demonstrate that more than half ofthe detained girls had mental health problems inyoung adulthood (59.0%), including high rates ofcomorbidity (41.5%). These findings are consistentwith the high levels of (comorbid) psychopathologyfound among female adolescents during detention(Abram et al., 2003), and suggest a continuedcourse of detained female adolescents’ mental healthproblems into young adulthood. Moreover, two out offive detained females developed either APD and/orBPD during young adulthood. Prevalence rates ofthese PDs were found to be much higher compared

0

1

2

3

4

5

Total Occupation, education and financial

Sexual andrelationship

Delinquentb

NoMH

Axis 1

PD

*** ***

***

Mea

n

Figure 1 Adjustment Problems by Mental Health Problems inEarly Adulthood. Note no MH indicates no mental health prob-lems; axis 1, only axis 1 mental problems; PD, personality disorder,***p < .001

Table 3 Detained adolescent females’ behavior problems andoffending characteristics as predictor of mental health inyoung adulthood

Mental health problems

ba SE 95% CI

SDQ scales T0Conduct problems 0.19 0.09 (0.00, 0.37)Hyperactivity/inattention 0.13 0.07 ()0.01, 0.27)Peer relationship problems 0.02 0.08 ()0.14, 0.18)Emotional symptoms 0.22* 0.06 (0.09, 0.34)Total difficulties score 0.08* 0.03 (0.03, 0.14)

Offense history T0Number of offenses 0.00 0.06 ()0.11, 0.11)Any violent offense 0.01 0.35 ()0.65, 0.68)

*p < .007.aControlling for time to follow-up, time in detention, and age.

Table 4 Detained adolescent females’ behavior problems and offending characteristics as predictor of social adjustment in youngadulthood

Occupation, education andfinancial

Sexual and relationship Delinquentb

ba SE 95% CI ba SE 95% CI ba SE 95% CI

SDQ scales T0Conduct problems 0.09 0.06 ()0.02, 0.20) 0.03 0.03 ()0.04, 0.09) )0.02 0.03 ()0.09, 0.04)Hyperactivity/inattention 0.12* 0.04 (0.04, 0.20) )0.02 0.03 ()0.07, 0.03) )0.06 0.02 ()0.30, 0.10)Peer relationship problems 0.05 0.05 ()0.05, 1.14) 0.02 0.03 ()0.04, 0.08) )0.00 0.03 ()0.06, 0.05)Emotional symptoms 0.12* 0.04 (0.05, 0,20) 0.00 0.02 ()0.04, 0.05) )0.02 0.02 ()0.06, 0.02)Total difficulties score 0.06* 0.02 (0.02, 0.09) 0.00 0.01 ()0.02, 0.02) )0.02 0.01 ()0.04, 0.00)

Offense history T0Number of offenses 0.00 0.03 ()0.07, 0.07) )0.03 0.02 ()0.07, 0.02) 0.08* 0.02 (0.04, 0.11)Any violent offense )0.08 0.20 ()0.47, 0.31) )0.01 0.12 ()0.25, 0.23) 0.20 0.11 ()0.02, 0.41)

*p < .007.aControlling for time to follow-up, time in detention, and age.bNumber of offenses after detainment.



to those in the general population (Grant et al.,2004).

In addition, almost all detained females had multi-ple adjustment problems in adulthood, similar toprevious longitudinal reports on nondetained

samples of antisocial adolescent females (Odgerset al., 2008; Pajer, 1998). Consistent with prior find-ings on youth re-entering society after detention, de-tained females in this study had socioeconomicdisadvantages (i.e., financial problems, low academicachievement) and demonstrated delinquent behaviorin young adulthood (Cernkovich et al., 2008; Lanctotet al., 2007).

Results regarding gender-specific outcomesrevealed that over half of the previously detainedfemale adolescents experienced violent interactionsin their intimate relationship. Several processes aresuggested to explain that antisocial women may beprone to a violent relationship, such as trait relevantgenes for this behavior and continuity from violentfamily interactions (Rhule-Louie & McMahon, 2007).In addition, a phenomenon called assortative matinghas been proposed, which implies that female ado-lescents and male adolescents with an antisocialhistory are likely to affiliate with similar others(Moffitt et al., 2001). Furthermore, risky sexualbehavior is common among detained females (Teplinet al., 2005), and results of the present study illus-trate that detained females continue to display suchbehavior in young adulthood. For example, consis-tent with high pregnancy rates reported in prior re-search (Kerr et al., 2009), we found that asubstantive proportion of detained females becamemother at an early age.

Furthermore, consistent with our expectations,detained females who developed a PD (BPD and/orAPD) in young adulthood had increased levels ofadjustment problems compared to the group withaxis I problems and the group with no mental healthproblems. This implies that prevention and treat-ment of mental health problems have the potential tolower detained females’ disability in young adult-hood, and for young women with PDs in particular.

The final finding demonstrates that although mostdetained females have multiple adversities in youngadulthood, diversity within outcomes could be pre-dicted by females’ behavior during detention. It isconceivable that certain behavioral problems impactadjustment once young females return to the com-munity. For example, consistent with prior researchon hyperactive children (e.g., Barkley, Fisher,Smallish, & Fletcher, 2006), detained females withincreased levels of hyperactivity had more difficultieson the occupation, education, and financial domainin adulthood. The fact that detained females with themost offenses prior to detention also committedmore offenses after detention is in line with longitu-dinal research in general population samples thatfound stability among females regarding their rate ofantisocial behavior (Moffitt et al., 2001). These

results provide important information developingtreatment. More detailed research is needed to un-ravel detained females’ pathways to specific mentaldisorders and adjustment problems.

The present study also has a number of limita-tions. First, mixed methods were used to measurepreviously detained females’ mental health problems(i.e., self reports and clinical interviews). Therefore,comparisons of mental health problems within thisstudy and with other research that may use differentmethods must be interpreted with caution. Second,using the youth instruments K-SADS-PL for mea-suring ADHD and the CPTSD-RI for PTSD at follow-up may have resulted in an underestimation of theprevalence rates of these disorders.

ConclusionThe extensive mental health and adjustment prob-lems of previously detained females in young adult-hood highlight the continuation of substantial coststo young women and society. Results of this studycorroborate the need for effective and targetedintervention (Steinberg, Chung, & Little, 2004).Detained females may be some of the most vulnera-ble in society, and therefore need support enteringadulthood both during detention and once they havereturned to the community. Specifically detainedfemales that developed BPD and/or APD in youngadulthood require continued mental health care.This subgroup was substantial in the present studyand had the most mental health and adjustmentproblems.

Unfortunately, effective treatment based ondetained girls’ needs is scarce (Hipwell & Loeber,2006). Additional research is needed to design andimplement gender appropriate interventions for de-tained females. The multiplicity of problems foundamong previously detained females underscores thatre-entry programs should not limit their focus to asingle domain, such as reducing delinquency or get-ting a job. A multimodal intervention for adjudicatedgirls demonstrated beneficial effects and supportsthe suggestion that interventions need to includevarious risk domains (Chamberlaine, Leve, & DeG-armo, 2007). Predictive findings of this study high-light the importance of screening during detention,as it is possible to identify detained girls at risk foradverse outcomes and offers targets for treatment.

Considering the overall outcome of the presentstudy, detained females’ offspring are likely to beexposed to multiple detrimental environmental fac-tors. Previously detained females’ circumstances areknown risk factors associated with the developmentof children’s conduct problems, such as disadvan-taged socioeconomic context, substancedependence, and parental partner violence (Van derMolen, Hipwell, Vermeiren, & Loeber, 2011).Preventing detained females’ risky sexual behaviorsby interventions designed to make healthy choices



may decrease abortion rates and unplanned earlypregnancy. To reduce intergenerational transmissionof conduct problems to the next generation, it wouldbe important to actively support families of previ-ously detained young mothers. Intervention for high-risk mothers that have shown promising results,including reduced disruptive behavior in offspring(Eckenrode et al., 2010) may also benefit previouslydetained females.

AcknowledgementsThis study is part of the research program MaGW (400-05-211), which is financed by the Netherlands Organi-sation for Scientific Research (NWO).

CorrespondenceElsa van der Molen, Leiden University Medical Center,Curium-LUMC, PO Box 15, 2300 AA, Leiden, theNetherlands. E-mail: [email protected]

Key points

• Scant longitudinal research on detained females has focused on re-offending.• The present study expands on a broad array of outcomes and indicates that a high proportion of detained

females face multiple mental health and adjustment problems in young adulthood.• Detained females that developed APD and/or BPD in young adulthood function significantly worse, with the

most mental health and adjustment problems.• Young adult mental health and adjustment problems were predicted by detained females’ behavior. These

predictors may be useful for identifying females at risk.

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Accepted for publication: 19 November 2012Published online: 23 January 2013



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